Worlds of Influence: Understanding What Shapes Child Well-Being in Rich Countries

Innocenti Report Card 16
Worlds of Influence
Understanding What Shapes Child
Well-being in Rich Countries
Innocenti Report Card 16 was written by Anna Gromada, Gwyther Rees and
Yekaterina Chzhen with contributions from Dominic Richardson, Céline Little and
David Anthony. The report was fact-checked by Alessandro Carraro, supervised
by Gunilla Olsson and Priscilla Idele and edited by Madelaine Drohan.
The United Nations Children’s Fund Office of Research – Innocenti (UNICEF
Innocenti) would like to acknowledge the generous support for Innocenti Report
Card 16 provided by the Government of Italy.
Any part of this Innocenti Report Card may be freely reproduced using the
following reference:
UNICEF Innocenti, ‘Worlds of Influence: Understanding what shapes child
well-being in rich countries’, Innocenti Report Card 16, UNICEF Office of
Research – Innocenti, Florence, 2020.
The Innocenti Report Card series is designed to monitor and compare the
performance of economically advanced countries in securing the rights of
their children.
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©United Nations Children’s Fund (UNICEF), 2020
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Worlds of Influence
Understanding What Shapes Child
Well-being in Rich Countries
E X E C U T I V E S U M M A R Y
2 I N N O C E N T I R E P O R T C A R D 1 6
EXECUTIVE SUMMARY
A new look at children from the What makes a good Skills for life
world’s richest countries offers a childhood? Many also lack basic academic and
mixed picture of their health, skills Good mental well-being social skills by the age of 15:
and happiness. For far too many,
issues such as poverty, exclusion
Feeling positive and being in good Two in five children (on average)
mental health are key aspects of do not acquire basic reading and
and pollution threaten their mental
quality of life. However, a striking mathematics skills by age 15. In
well-being, physical health and
number of children in rich countries seven countries, the number
opportunities to develop skills.
do not have good mental well-being: drops to less than one in two.
Even countries with good social,
economic and environmental In 12 of 41 countries, less than For an equally important skill
conditions are a long way from 75 per cent of children aged 15 set – feeling confident in
meeting the targets set in the have high life satisfaction. developing interpersonal
2030 Agenda for Sustainable relationships – most children
Development. Focused and There are no reliable, comparable agree that they make friends
data on children’s mental health
accelerated action is needed if easily. But in 18 countries more
across this set of rich countries.
these goals are to be met. than one in four children
But suicide is one of the most
The evidence from 41 common causes of death for disagree.
Organisation for Economic adolescents aged 15 to 19.
Why do all children in rich
Co-operation and Development
Good physical health countries not have a good
(OECD) and European Union (EU)
Health indicators also highlight childhood?
countries tells its own story: from
areas of concern: Poor-quality relationships
children’s chances of survival,
growth and protection, to whether 1 in 15 infants in rich countries is Children view good relationships
they are learning and feel listened born with low weight – a key risk as crucial. Those with more
to, to whether their parents have to survival. supportive families have better
the support and resources to give mental well-being.
their children the best chance for In 10 countries, more than one in
a healthy, happy childhood. This three children is overweight or Many children feel that they lack
obese. The number of obese opportunities to participate in
report reveals children’s decisions at home and at school.
experiences against the backdrop children (aged 5–19) worldwide
of their country’s policies and is expected to grow from 158
social, educational, economic and million to 250 million by 2030.
environmental contexts.
I N N O C E N T I R E P O R T C A R D 1 6 3
Bullying by peers remains a Adolescents disengaged from Consult children. They see
serious problem; it has a lasting education and the labour market things from a different viewpoint
negative impact on relationships face a difficult start to adult life. and express serious concern for
and health. Children who are In five rich countries, more than the future of the environment,
frequently bullied have lower 10 per cent of young people how much they value
mean life satisfaction. aged 15 to 19 are not in relationships and participating
education, training or work. in decisions.
In some countries, at least 1 in
10 parents report no family or Gaps in family policy Connect policies. Carefully
friends they can count on for help integrated policies that
In five rich countries, parental
with looking after their children. leave is less than 10 weeks (full- complement and strengthen one
pay equivalent). Leave reserved another are key to improving
Lack of resources
for fathers makes up only one child well-being.
In almost half of rich countries, tenth of all parental leave.
more than one in five children Create strong foundations. The
live in poverty. In many countries, Expectations to prioritize work Sustainable Development Goals
the poorest children are at can lead to long hours and stress provide a roadmap to ensuring
greater risk of depression, that reduce the time and energy child well-being now and for the
obesity and low academic parents have for their children. future. Governments should
achievement. On average, two out of five intensify and accelerate their
employees in Europe found it efforts to meet these goals,
Children without books at home difficult to fulfil family including:
to help with school work suffer
responsibilities at least several 1. Reduce poverty, and ensure
academically.
times per month. that all children have access to
More time playing outside is The broader context the resources they need.
linked to much higher levels of
happiness. Yet many children say Unemployment – which affects 2. Improve access to affordable
that good play and leisure family relationships and child and high-quality early years
facilities are not available in their well-being – has still not dropped childcare for all children.
neighbourhoods. below its pre-Great Recession
3. Improve mental health
levels in some countries.
Gaps in services services for children and
Measles immunization rates have In 11 of 41 countries, at least adolescents.

5 per cent of households do not
dropped in 14 out of 35 countries 4. Implement and expand family-
have safely managed water.
with available time-series data. friendly policies related to the
Public provision of high-quality High levels of air pollution still workplace.

threaten the physical and mental
childcare provides a stimulating 5. Reduce the stubbornly high
health of children – who suffer
social and learning environment – levels of air pollution.
the greatest harms.
and helps to reduce socio-
6. Strengthen efforts to
economic disadvantage. And yet, What needs to be done?
immunize children against
on average, across 29 European For every child to enjoy a good preventable diseases.
countries, one in seven parents childhood, UNICEF calls on
with a child under 3 has unmet high-income countries to act
childcare needs. on three fronts:
S E C T I O N 1 I N T R O D U C T I O N
SECTION 1
INTRODUCTION
The COVID-19 crisis that has responsibilities of governments, the virus. But, as we know from
engulfed the world during 2020 families and communities to help previous crises, they will be a
presents new threats to child well- realize children’s rights and group that experiences the
being. Even before the crisis, in the promote their well-being. longer-term negative impacts most
world’s richest countries, the daily acutely. In this report, we present
This report finds that many of the
lives of millions of children fell far a baseline picture of children’s
wealthiest countries do not
short of what anyone would call a well-being in rich countries at the
manage to convert good economic
good childhood. They suffered start of the current crisis. In a
and social conditions into
stress, anxiety and depression, companion paper, we look ahead to
consistently high child well-being
lagged behind their peers at school, how the crisis may affect child
and were physically unwell. Living in outcomes. It shows that no country well-being over the coming years.
a wealthy country did not bring them is a leader on all fronts, and that all
41 countries have significant room The time is right for countries to
happiness. Nor did it guarantee
for improvement. Such step up efforts to realize the rights
them better health or education.
improvement is urgently needed if of all children. A multi-level
For the last 20 years, the Innocenti the world’s most affluent nations approach to child well-being can
Report Card series has led the way are to meet the commitments they support this goal because it
in comparing children’s well-being made five years ago when they delivers a realistic picture. It
across rich countries. Report Card endorsed the 2030 Sustainable clarifies the links between the
16 develops this further through a Development Goals. Yet there are outcomes of individual children, the
multi-level approach to show that people and communities around
worrying signs of back-sliding on
children’s well-being is influenced them, and the nation in which they
aspects such as immunization,
by children’s own actions and live. Many countries have all the
learning and mental health.
relationships, by the networks and requisites – wealth, a clean
resources of their caregivers, and The COVID-19 crisis adds to these environment and generous social
by public policies and the national challenges. What started as a policies – to support high levels of
context. This approach is aligned health crisis will spread to touch all child well-being. Yet too many
with the 1989 United Nations aspects of economies and children in these countries still do
Convention on the Rights of the societies. Children will not suffer not experience a good childhood.
Child, in that it recognizes the the worse direct health effects of
Our framework The world at large entails Policies economic, social and environmental
We view a good childhood as one and Context (the two outer circles factors that influence child well-
in which children have a positive in light blue). Policies refer to being either directly or indirectly.
experience of childhood and the national programmes of direct Policies and Context are national
prospect of a good future.1 We relevance to the child, including conditions for well-being that
develop a multi-level approach to social policy, education and health. potentially explain variations in child
well-being and adapt it for Context includes broader well-being between countries.
international comparisons. Our
model of concentric spheres of
influence is similar to the one
developed by American
psychologist Urie Bronfenbrenner
Figure 1: A multi-level framework of child well-being
to explain how children interact
with their environment and how
this influences their development
(see Figure 1).2
The child stands at the heart of the
framework. Child well-being Context
outcomes can be objective, such
as child mortality or educational
achievement. They can also be Policies
subjective and expressed from the
child’s point of view, for example
whether they are satisfied with life Resources
or feel they can make friends easily.
Outcomes are influenced by the
world of the child, the world around Networks
the child and the world at large.
The world of the child (in dark blue)
represents factors experienced ationships
directly by a child: the child’s
Rel
Activities and Relationships, such
as those with family and peers. The
world around the child (in medium Activities
blue) consists of Resources and
Networks. Resources include
children’s household economic
status and the quality of the
neighbourhoods they live in. Outcomes
Networks are the connections
between people around the child,
which the child may not directly
experience, but which can affect
their well-being. An example is The world of the child
work pressure on their parents.
These four inner circles of the The world around the child
framework can explain variations
between children within countries. The world at large
Spotlight 1 About the data used in this report
This is our third study of multidimensional child well- of books that a child has at home is often used as an
being in rich countries and it builds on our previous objective measure of home educational resources, but
work. Report Card 7 broke new ground by it may have different significance in different
comparing child well-being across 21 countries. countries.3 Subjective indicators may also vary in
It had a major impact on public discourse and on meaning. For example, there may be cultural
policymakers. Report Card 11 extended the number differences in self-evaluations of life satisfaction,4
of countries to 29 and updated the rankings. Report although it is possible to explain most of the variation
Cards 7 and 11 took a dashboard approach, between countries in mean life satisfaction scores
assessing aspects of children’s physical, cognitive based on national social and economic conditions.5
and mental well-being side-by-side.
Where a number of options met these criteria, we
Report Card 16 introduces a multi-level framework prioritized the continuity of indicators from previous
and expands the coverage of child well-being both multidimensional Report Cards.
conceptually and geographically. It covers 41 high-
Data gaps
income countries (members of the OECD and/or the
EU). The report also adopts a broader outlook on child In many cases our choices were limited or there was
well-being. For example, we consider social skills to a lack of comprehensive data. Some of the most
be of equal value to academic skills so we included a important data shortages or gaps that we highlighted
new indicator for making friends easily. We also pay in our search for indicators were:
more attention to environmental factors given how
worried children are about the future of the planet.
Mental well-being. There are limited data on
children’s positive sense of well-being and flourishing.
These innovations, along with missing data, reduced The best indicator we could find – life satisfaction –
the potential for comparisons of Report Card 16 with was only available for 33 of the 41 countries. There is
Report Cards 7 and 11. Yet, to help with tracking also a shortage of comparable international data on
well-being trends, we updated those elements of the children’s mental ill-health. We have used suicide
previous Report Cards for which we have new data. rates as a proxy but for many countries these data
were only available up until 2015.
Criteria for data selection
Report Card 16 employs an array of data from high- Violence and protection. We were not able to find
any comparable indicators either on children’s
quality administrative datasets and international
experience of violence or on child protection policies.
surveys. Indicators were chosen to represent key
concepts within our framework (see Figure 1). Our Participation. Children’s experiences of being able
selection of key indicators for the league tables was to participate, have their views heard or make
guided by the following criteria: choices are hardly covered in most international
surveys. Only one such survey – Children’s Worlds –
Coverage. Data should be available for the large which currently covers a minority of OECD/ EU
majority of the 41 Report Card countries.
countries, asks about these issues or about
Recency. Data relating to 2016 or later should children’s knowledge of their rights.
be available.
These are three topic areas that urgently need to be
Relevance. The data should be relevant to cross- addressed by government statistical departments and
national comparisons. the international research community.
Variability. There should be enough variability in The application of the well-being framework to the
the indicators between countries to be COVID-19 crisis can be found in Rees, Gwyther, Anna
informative. Gromada, Dominic Richardson and Alessandro Carraro,
Childhood in a Time of Crisis: Understanding how the
Comparability. The indicators should have the COVID-19 pandemic is shaping child well-being in rich
same meaning across cultures.
countries, United Nations Children’s Fund Office of
The last criterion presents challenges for objective Research – Innocenti, Florence, 2020.
and subjective indicators. For example, the number
Figure 2 shows how we have additional dimensions. For example,

applied the framework presented child protection and
in Figure 1 for this report. Our implementation of children’s rights
selection of dimensions within each could be added to the Policies
sphere of the framework reflects sphere, and peace and security to
available data. Future work using the Context sphere.
the framework could include
Figure 2: Overview of the application of the framework for this report
Society
orld at large
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School
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Wo
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world the chil

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Outcomes
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Soc
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Mental well-being
ialis
Life satisfaction,
e
suicide
Skills
Reading/mathematics,
making friends
Physical health
Overweight/obesity,
mortality
Box 1: Indicators used in the report
Dimension Components Indicators Source

Life satisfaction Percentage of children with high life satisfaction at 15 PISA, 2018
Mental well-being WHO Mortality
Adolescent suicide Suicide rate for 15- to 19-year-olds
Database, 2015
Outcomes
Child mortality Child mortality rate (all causes), 5–14 UN IGME project, 2018
Physical health State of the World’s
Overweight Percentage of children overweight, 5–19
Children, 2016
Percentage proficient in mathematics and reading
Academic proficiency PISA, 2018
Skills at 15
Social skills Percentage who make friends easily at school at 15 PISA, 2018
Frequency of playing outside at 10 years old
Activities
Play Playing outside Children’s Worlds, 2017–19

(days per week)
Digital Internet use Average duration of Internet use by children EU Kids Online, 2018–19
Level of family support reported by children at
Family support HBSC, 2017/18
15 years old
Family
Relationships
Percentage of children aged 10 totally agreeing that

Family participation Children’s Worlds, 2017–19
they participate in decision-making at home
Peers Being bullied Frequency of children being bullied at 15 years old PISA, 2018
School belonging Sense of belonging at school at 15 years old PISA, 2018
School Percentage of children aged 10 totally agreeing that
School participation Children’s Worlds, 2017–19
they participate in decision-making at school
Parental support Main sources of support for parents in looking European Quality of Life
Parent–community
networks after children Survey, 2016
Percentage of employees struggling to fulfil family European Quality of Life
Networks
Work–family balance
responsibilities Survey, 2016
Parent–work
OECD based on Labour
Hours worked Average weekly hours worked on main job
Market Statistics, 2017
European Quality of Life
Parent–school Relationship with school Parents’ rating of their relationship with school
Survey, 2016
Percentage of children aged 15 having books at
Resources
Household resources School books at home PISA, 2018

home to help with school work
Neighbourhood Percentage of children aged 10 who agree that
Local play facilities Children’s Worlds, 2017–19
resources there are enough places to play in their local area
Weeks of full-rate equivalent parental leave OECD Family Database,
Parental leave
in early childhood 2018
Family policy Eurostat, HILDA, LIS and
Percentage of children in households below 60% of
Child poverty national statistical agencies,
median income
2018
Policies
Early childhood Percentage of children attending early childhood UNESCO, 2017, Report Card
education and care education and care one year before school 15 and UNSTATS
Education
Percentage of 15- to 19-year-olds out of school, OECD Family Database and
NEET
employment or training Eurostat, 2018
Immunization Measles immunization WHO/UNICEF, 2018
Health Percentage of newborns weighing less than OECD Health Database and
Low birthweight
2,500 grams WHO, 2017
Income Gross national income per capita in international dollars World Bank, 2018
Economy
Jobs Unemployment rate (percentage of active population) World Bank, 2019
Social support Percentage of adults who have someone to count on Gallup World Poll, 2016–18
Context
Society
Violence Homicide rate World Bank, 2017
Global Burden of Disease
Air pollution Mean levels of fine particulate matter PM2.5
Study, 2017
Environment
WHO/UNICEF Joint
Water quality Percentage of population using safe water
Monitoring Programme, 2017
S E C T I O N 2 O U T C O M E S
SECTION 2
OUTCOMES
For this section, we consider two The rationale for the inclusion of The rankings of some countries vary
questions. these components, indicators and widely from one well-being outcome
their sources is explained later in to another. For example, the Republic
1. How do children experience their
this section. We were unable to of Korea is in the top third for
lives in the present?
include 3 of the 41 countries – physical health and skills, but in the
2. And what are their prospects for Israel, Mexico and Turkey – in the bottom third for mental well-being.
the future? league table of well-being In contrast, Romania is ranked fourth
These questions are related. For outcomes due to shortages of data highest for mental well-being but is
example, having good health leads (see note to Figure 3). However, in the bottom third for the physical
to both current and future well- these three countries are included, health and skills dimensions.
being. To address these questions, where possible, throughout the
The physical health and skills
we focus on indicators that directly rest of the report.
dimensions are moderately
describe the well-being outcomes The Netherlands ranks highest in the correlated (r=0.58), meaning that if
of the child. league table of outcomes, followed a country reports good results in
Our league table of child well-being by Denmark and Norway. These one of these dimensions, it is likely
outcomes corresponds to the three countries along with to report good results in the other.
innermost circle of our model (see Switzerland and Finland are in the But skills are less strongly correlated
Figure 3). It consists of three top third of rankings in all three with mental well-being (r=0.30),
dimensions (see Box 1): outcomes. Chile, Bulgaria and the while physical health and mental
United States of America are at the well-being are even more weakly
Mental well-being: This includes bottom of the table. Only Chile, the linked (r=0.10). This highlights the
both positive and negative aspects United States and Malta are in the multidimensional nature of child
of a child’s mental well-being – life bottom third of rankings for each of well-being outcomes.
satisfaction and suicide rates. the three well-being outcomes.
National income is clearly no
Physical health: This includes
rates of overweight and obesity, guarantee of the best outcomes.
which affect children now and in Each third of the league table
future, and child mortality. contains a mixture of countries with
contrasting income levels. For
Skills: This dimension focuses example, Slovenia ranks above
both on academic skills – Sweden in the top third, while in the
proficiency in reading and bottom third Lithuania fares better
mathematics; and social skills – than the United States.
feeling able to make friends easily.
1 0 I N N O C E N T I R E P O R T C A R D 1 6
Figure 3: A league table of child well-being outcomes: mental well-being, physical health, and academic
and social skills
Overall ranking Country Mental well-being Physical health Skills

1 Netherlands 1 9 3
2 Denmark 5 4 7
3 Norway 11 8 1
4 Switzerland 13 3 12
5 Finland 12 6 9
6 Spain 3 23 4
7 France 7 18 5
8 Belgium 17 7 8
9 Slovenia 23 11 2
10 Sweden 22 5 14
11 Croatia 10 25 10
12 Ireland 26 17 6
13 Luxembourg 19 2 28
14 Germany 16 10 21
15 Hungary 15 21 13
16 Austria 21 12 17
17 Portugal 6 26 20
18 Cyprus 2 29 24
19 Italy 9 31 15
20 Japan 37 1 27
21 Republic of Korea 34 13 11
22 Czech Republic 24 14 22
23 Estonia 33 15 16
24 Iceland 20 16 34
25 Romania 4 34 30
26 Slovakia 14 27 36
27 United Kingdom 29 19 26
28 Latvia 25 24 29
29 Greece 8 35 31
30 Canada 31 30 18
31 Poland 30 22 25
32 Australia 35 28 19
33 Lithuania 36 20 33
34 Malta 28 32 35
35 New Zealand 38 33 23
36 United States 32 38 32
37 Bulgaria 18 37 37
38 Chile 27 36 38
Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in the
table were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive outcome); (2)
we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, we then calculated the
mean of the mean z-scores for each dimension. This table includes the 38 OECD/EU countries which had data of sufficient quality across at least five of the six Outcomes
indicators listed in Box 1. We were unable to include Mexico and Turkey due to low coverage rates in the Programme for International Student Assessment (PISA) 2018
survey (which provides three of the six indicators that make up the league table). We were also unable to include Israel as data were missing on two of the six indicators.
I N N O C E N T I R E P O R T C A R D 1 6 1 1
Mental well-being In some countries, less than two thirds of children have high life satisfaction
Mental well-being means not only Figure 4: Percentage of children with high life satisfaction at 15 years of age
the absence of mental ill-health
but also a broader sense of positive
Netherlands 90
functioning.6 We represent both
of these aspects in the first Mexico 86
league table. Romania 85
Positive functioning encompasses Finland 84
various components including Croatia 82

emotions such as feeling happy, Switzerland 82
satisfaction with life and a sense of 82
Spain
flourishing. The league table
Lithuania 82
includes a question about life
satisfaction from the Programme Iceland 81
for International Student France 80
Assessment (PISA) study, based on Estonia 78
the criteria for indicator selection
Portugal 78
(see Spotlight 1). Children aged 15
Latvia 78
years were each asked to say how
satisfied they felt with their life as a Austria 77
whole using a scale from 0 (worst Slovakia 77
possible life) to 10 (best possible Hungary 77
life). In all countries, most children
Italy 76
were reasonably satisfied with their
lives (a score above the midpoint Sweden 76
on the scale), but there was Greece 76

variation between countries in this Luxembourg 76
regard – ranging from less than
Germany 75
55 per cent of children in Turkey
Czechia 73
to 90 per cent of children in the
Netherlands (see Figure 4). Bulgaria 73
Slovenia 72
The fact that most children are
reasonably satisfied with their lives Ireland 72
is encouraging. We still need to Chile 72
consider what these percentages Poland 72
mean in terms of the large
United States 71
numbers of children who have low
Malta 70
life satisfaction. This is more than
merely a question of momentary Republic of Korea 67
‘happiness’. For example, a study in United Kingdom 64
the United Kingdom showed that, Japan 62
compared with children with
Turkey 53
average to high life satisfaction,
those with low life satisfaction 0 20 40 60 80 100
were about eight times as likely to Percentage of children with high life satisfaction (>5 out of 10)
report family conflict, six times as
likely to feel that they could not Note: Percentage of children scoring more than 5 out of 10 on the Cantril Ladder for satisfaction
with life as a whole. No data available for Australia, Belgium, Canada, Cyprus, Denmark, Israel,
express their opinions, five times as New Zealand and Norway.
likely to be bullied, and more than Source: Programme for International Student Assessment (PISA) 2018.
More than 10 in 100,000 adolescents aged 15–19 years commit twice as likely not to look forward
suicide in some rich countries to going to school.7 Only 64 per
Figure 5: Suicide rate per 100,000 adolescents aged 15–19 years cent of children with low self-
reported well-being felt they had
Greece 1.4
people who supported them,
Portugal 2.1
compared with 93 per cent of other
Israel 2.2
Cyprus 2.4
children. And 24 per cent of
Turkey 2.4 children with low well-being said
Italy 2.5 that they did not feel safe at home,
Spain 2.6 compared with only about 1 per
France 3.4 cent of other children.
Denmark 3.6
There is a lack of reliable,
United Kingdom 3.7
comparable data on mental ill-
Slovakia 4.2
4.3
health among children globally. As
Bulgaria
Germany 4.4 in previous Report Cards, we used
Hungary 4.5 the suicide rate among adolescents
Netherlands 4.8 aged 15–19 years as the best
Norway 5.1 available indicator. Unfortunately,
Romania 5.1 data were only generally available
Slovenia 5.6 up to 2015. Suicide rates in this age
Luxembourg 6.0 group were above 10 per 100,000
Belgium 6.1 in Lithuania, New Zealand and
Ireland 6.4 Estonia, and lowest in Greece,
Croatia 6.6
Portugal and Israel.
Czechia 6.7
Malta 6.8 Physical health
Switzerland 7.0 The full extent of the health
Mexico 7.1 outcomes associated with
Austria 7.2
childhood and adolescence only
Sweden 7.3
becomes apparent later in life.
Republic of Korea 7.3
There are, however, some useful
Japan 7.5
indicators relating to children’s
Chile 8.0
Finland 8.2
physical health during childhood.
United States 8.7 Here we look at two indicators that
Poland 8.8 have also been included in previous
Canada 9.0 Report Cards: child mortality and
Latvia 9.5 overweight (including obesity).
Australia 9.7
For child mortality, we use the
Iceland 9.7
mortality rate for children aged 5–14
Estonia 13.9
years, provided by the United
New Zealand 14.9
Lithuania 18.2 Nations Inter-agency Group for Child
Mortality Estimation.8
0 2 4 6 8 10 12 14 16 18 20
Suicide rate per 100,000 people aged 15–19 years

(three-year moving average)
Notes: Figures are three-year averages for 2013–2015, except that: (1) data were only available for two of
these three years in Greece, New Zealand and Slovakia; and (2) five-year averages are used for the following
three countries that had fewer than 50,000 people in this age group – Cyprus, Iceland and Luxembourg.
Source: World Health Organization Mortality Database (numbers of suicides) and World Bank database
(population estimates).
In more than a quarter of countries, child mortality rates are Figure 6 shows a wide range of
still over 1 per 1,000 rates, with child mortality about
Figure 6: Mortality rate per 1,000 children aged 5–14 years, 2018 four times higher in Mexico than it
is in each of the six countries with
Luxembourg 0.36 the lowest rates. Among the 41
Denmark 0.50 countries, the child mortality rate is
Finland 0.60 the outcome indicator most closely
Norway 0.63 associated with national income
Ireland 0.64 and inequality (see Spotlight 6).
Switzerland 0.66 Among the richer countries in our
Spain 0.71 list, the United States stands out.
Germany 0.72 It has a higher child mortality rate
Japan 0.73 than countries with similar levels
Italy 0.73 of per capita income.
Slovenia 0.74
Republic of Korea 0.75
The second indicator of physical
Iceland 0.78
health is overweight and obesity.
United Kingdom 0.78
Being overweight is defined as
Sweden 0.79
having a body mass index (BMI) of
over 25, while obesity is indicated
Austria 0.80
by a BMI of over 30. Obesity is a
France 0.80
serious problem for both medical
Belgium 0.80
and psychological reasons. It
Netherlands 0.81
contributes to diabetes,
Czechia 0.81
cardiovascular diseases,
Malta 0.84
hypertension, cancer, gallbladder
Australia 0.84
disease and a shorter life
Portugal 0.87
expectancy.9 It takes a social and
New Zealand 0.87
emotional toll by limiting
Cyprus 0.90
participation in social life and
Israel 0.94
lowering self-esteem.
Hungary 0.97
Canada 0.98 In recent years, rates of overweight
Greece 1.05 and obesity have increased
Croatia 1.13 substantially in high-income
Poland 1.16 countries. For example, obesity
Estonia 1.22 among children and adolescents
United States 1.34 aged 2–19 years in the United
Lithuania 1.41 States has risen by more than one
Slovakia 1.42 third in the last 15 years.10 The
Latvia 1.46 global picture is bleak. The number
Chile 1.49 of obese children and adolescents
Romania 1.80 aged 5–19 years worldwide is
Bulgaria 1.93 expected to grow from 158 million
Turkey 1.96
Mexico 2.47
0 0.5 1.0 1.5 2.0 2.5 3.0
Mortality rate per 1,000 children aged 5–14 years
Source: United Nations Inter-agency Group for Child Mortality Estimation project.
in 2020 to 254 million by 2030.11 In 10 countries, more than one in three children and
The recent rise in obesity appears adolescents is overweight (including obese)
to be linked with lifestyle changes Figure 7: Percentage of young people aged 5–19 years who
and insufficient regulation of food were overweight or obese in 2016
production and advertising,
Japan 14
including predatory commercial
Estonia 20
practices, which could be
Lithuania 21
addressed by governments.12
Latvia 21
Unlike the mortality indicator, there Switzerland 22
is no clear link between overweight/ Slovakia 23
obesity rates and national income Sweden 24
among the rich countries included Belgium 24
in this report. There do appear to be Romania 25
some geographical patterns. Lower Netherlands 25
rates tend to be found mostly in Denmark 25
countries in the northern half of Poland 26
Europe and East Asia. Higher rates Luxembourg 26
are found primarily in countries Germany 27
around the Mediterranean and in Austria 27
the Americas and Oceania. Finland 27
Slovenia 27
Skills
Czechia 27
Learning new skills can be a Norway 27
rewarding experience for children in Republic of Korea 28
the present, as well as a foundation Croatia 28
for adulthood. Child well-being Iceland 28
indices often include indicators of Hungary 28
skills development, but the focus Bulgaria 28
has usually been on academic skills. Turkey 30
Social and emotional skills are also France 30
important both during childhood Ireland 31
and as a foundation for adulthood. United Kingdom 31
These types of skills are also Canada 32
increasingly seen as important for Portugal 33
employability. With this in mind, we Cyprus 33
aimed to include in our two Spain 34
indicators for the skills dimension – Australia 34
a measure of educational Israel 35
achievement near the end of Mexico 36
compulsory secondary education Chile 36
and a measure of social skills. Italy 37
Malta 37
Greece 37
New Zealand 39
United States 42
0 5 10 15 20 25 30 35 40 45
Percentage of children aged 5–19 years
who are overweight or obese
Source: United Nations Children’s Fund, The State of the World’s Children 2019. Children, Food and
Nutrition: Growing well in a changing world, UNICEF, New York, 2019.
Spotlight 2 Body image relates to life satisfaction

twice as strongly for girls than for boys
How adolescents feel about their bodies has an impact In those countries for which we have data, the
on their well-being. A positive body image is linked to proportion of children aged 11, 13 and 15 years who
greater self-confidence. A negative body image can were dissatisfied with their own body ranged from
lead to shame, anxiety, depression, isolation and low more than 33 per cent in Iceland to 55 per cent in
self-confidence.13 It is also the strongest contributor to Poland. More children overall thought they were too fat
anorexia and bulimia.14 For example, in the United (29 per cent) than too thin (16 per cent). Based on
States, most adolescent girls and one third of weight and height measurements, 23 per cent of girls
adolescent boys report unhealthy attempts at weight and 27 per cent of boys aged 15 years were actually
control, such as smoking, fasting, vomiting or taking overweight.16 Yet, girls of this age were more likely to
weight-regulating drugs.15 see themselves as fat (34 per cent) than boys (24 per
In most rich countries, more than two in five adolescents are dissatisfied with their bodies
Figure 8: Percentage of adolescents aged 11, 13 and 15 years who say they are too fat or too thin
60
50
Average: 45%
40 16
Percentage
16
15
21
17
14
17
15
16
13
12
16
12
11
12
13
16
30
16
18
18
16
14
15
13
14
18
23
16
27
20
14
23
17
17
13
20
10
20
21
24
27
27
24
25
27
30
30
27
29
31
27
31
26
29
24
32
29
28
28
33
31
24
32
32
25
33
34
33
25
36
33
38
0
Iceland
Malta
Canada
Italy
UK (England)
Croatia
France
Ireland
Finland
Denmark
Sweden
UK (Wales)
Netherlands
Bulgaria
Greenland
Romania
Lithuania
Slovakia
UK (Scotland)
Slovenia
Portugal
Spain
Belgium (Flemish)
Switzerland
Israel
Hungary
Belgium (French)
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Poland
Percentage of adolescents who think they are too fat Percentage of adolescents who think they are too thin
Source: Health Behaviour in School-aged Children (HBSC) 2018.
cent). This suggests that many children with a healthy enormously (see Figure 9). It does not impact boys in
weight think they are fat, particularly girls. The numbers Bulgaria, where 1 in 10 boys is overweight. It is
are very similar at the ages of 11, 13 and 15 years, strongest for girls in Scotland (United Kingdom),
indicating that these negative feelings may have started Finland, the Netherlands and Ireland.
even before adolescence.
Girls who are satisfied with their bodies typically come
Body image is much more closely linked to life from families and peer groups who express fewer
satisfaction for girls. On average, body image explains weight-related concerns and emphasize positive body
10 per cent of the differences in life satisfaction of girls behaviours (such as exercising and eating well) as
and 5 per cent of the differences for boys. Yet the link opposed to negative behaviours (such as dieting).17
between body image and life satisfaction varies
The link between body image and life satisfaction is twice as strong for girls than boys
Figure 9: Percentage of differences in life satisfaction accounted for by body image
18
16
14
satisfaction related to body image
Percentage of differences in life
12
10
0
Bulgaria
Israel
Luxembourg
Slovakia
France
Belgium (Flemish)
Estonia
Belgium (French)
Italy
UK (England)
Romania
Hungary
Czechia
Greenland
Malta
Switzerland
Portugal
Poland
Lithuania
Croatia
Germany
Austria
Iceland
Slovenia
Canada
Latvia
Sweden
Denmark
Greece
Spain
UK (Wales)
Ireland
Netherlands
Finland
UK (Scotland)
Girls Boys
Notes: R-squared from regression model controlled for age with full weights. All regression coefficients significant at p=.01, apart from
for boys in Bulgaria.
Source: Health Behaviour in School-aged Children (HBSC) 2018 (weighted and clustered).
For educational achievement, we Many children still reach 15 years of age without having basic
focus on the proportion of children reading and mathematics skills
who meet basic standards of Figure 10: Percentage of children aged 15 years with basic
proficiency. We also take into proficiency in reading and mathematics
account the percentage of children
Estonia 79
who are still in school in each
Ireland 78
country at the age of 15. For this
Finland 78
purpose, we use Coverage Index 3
Slovenia 75
from the PISA study, which can be
Japan 73
viewed as a measure of verified
Germany 73
enrolment.18 Our indicator is the
Poland 72
estimated proportion of the total
Republic of Korea 70
child population who are still in
Denmark 69
school and have reached a basic
Czechia 69
level of proficiency in both reading
Belgium 69
and mathematics (see Figure 10). It
Norway 68
can be interpreted as a minimum
Canada 68
estimate of the level of proficiency
in the child population at 15 years Spain 67
of age. Even in the best-performing France 67
country, Estonia, more than one Netherlands 66
in five children do not meet the New Zealand 65
basic proficiency standard. In five Switzerland 65
countries, less than half of children Sweden 64

do so. Latvia 64
Australia 64
United Kingdom 63
Austria 63
Portugal 63
Iceland 62
Lithuania 61
Hungary 61
United States 60
Italy 58
Croatia 58
Malta 57
Luxembourg 56
Slovakia 54
Greece 53
Israel 48
Cyprus 45
Chile 40
Romania 34
Bulgaria 32
0 10 20 30 40 50 60 70 80 90
Estimated percentage of children aged 15 years who have basic
proficiency in both reading and mathematics
Note: The percentage of children meeting or exceeding basic proficiency in both reading and
mathematics tests, multiplied by the Coverage Index 3 of the PISA survey.
Source: Programme for International Student Assessment (PISA) 2018, except for Spain (figures for Spain
from PISA 2015, as 2018 data were unavailable).
Our second indicator focuses on Many 15-year-old children do not feel confident in their skills to make friends
social skills. We use a question Figure 11: Percentage of children aged 15 years who make friends easily
asked in the PISA study about
whether children feel that they are Romania 83
able to make friends easily. We view Norway 82
this indicator as tapping into the Croatia 82
extent to which children feel Netherlands 81
confident in developing Spain 81
interpersonal relationships. This France 81
type of skill is likely to be beneficial Cyprus 81
to children both in the present and Italy 79
in adulthood in all aspect of their Belgium 79
lives. Figure 11 shows the Hungary 79
percentage of children who agreed
Denmark 79
or strongly agreed that they make
Slovenia 79
friends easily. Romania ranks
Switzerland 79
highest on this indicator and is one
of seven countries where more than
Sweden 77
four in five children felt that they
Austria 77
make friends easily. In two countries
Ireland 76
– Chile and Japan – less than 70 per
Portugal 76
cent of children felt this way.
Australia 76
Our analysis of this range of Luxembourg 75
important well-being outcomes Greece 75
presents a challenge to Finland 75
policymakers. While all countries Canada 74
can feel positive about their New Zealand 74
position in the rankings on one or
Bulgaria 74
more of these key indicators, none
Mexico 74
can feel satisfied with their position
United Kingdom 73
on all six. And even in countries at
Czechia 73
the top of the rankings, there are
Turkey 72
still many children who are falling
United States 72
behind. In subsequent sections, we
Germany 72
will try to understand what factors
Slovakia 72
lie behind these variations in child
Latvia 71
well-being outcomes and therefore
Lithuania 71
what improvements can be made.
We begin by looking at factors Malta 71
close to the child – their daily lives Estonia 71
and their closest relationships – Poland 70

and then gradually move outwards, Iceland 70
towards the broader conditions Japan 69
within societies that also have an Chile 68
impact on children’s experiences 0 10 20 30 40 50 60 70 80 90
and well-being. Percentage of children aged 15 years who make friends easily
Note: The percentage of children aged 15 years who agreed or strongly agreed that they make friends
easily at school.
Source: Programme for International Student Assessment (PISA) 2018, except for Cyprus (figures for
Cyprus from PISA 2015, as 2018 data were unavailable) and Israel (no data available).
S E C T I O N 3 T
H E W O R L D O F T H E C H I L D
SECTION 3
THE WORLD OF THE CHILD
How direct experiences differentiate child
well-being within countries
In this section and the next, we

look at the four levels of the
framework closest to outcomes, as
they can help us to understand
Context
why, within the same country,
some children have higher well-
being than others.19 We start with
Policies
‘the world of the child’: the
activities in which children are
involved and their relationships with
Resources people close to them such as
parents, peers and teachers.
Activities
Networks
Children’s activities inform us about
their daily lives. These activities
may not always be chosen by
ationships
Rel children and may reflect the
priorities of others, for example,
their parents. Indeed, children
Activities spend substantial amounts of time
in compulsory schooling. In 2018,
across OECD countries, the
average compulsory instruction
time per pupil in lower secondary
Outcomes school ranged from 766 hours per
year in Slovenia and Sweden to
1,200 hours per year in Denmark.20
International comparative studies of

The world of the child
children’s daily lives outside of
school are rare. We use new data
The world around the child on children’s activities in 15 rich
countries from the latest wave of
The world at large the Children’s Worlds survey.
Children were asked how often
during the last week they had done
S E C T I O N 3 T
15 different activities – for example, Children who play outside often are happier than children who do not
helping around the home, doing Figure 12: Mean happiness scores of children who played outside rarely
homework, using a computer and and those who did so daily
spending time playing outside.
9.0
We were interested to see which of UK (Wales)
7.0
these activities were linked with
9.4
children’s sense of well-being, Poland
7.5
based on how happy they had felt
in the past two weeks. Here we 9.1
Finland
choose happiness rather than life 7.6
satisfaction as an indicator because 9.0

Israel
it is likely to be more closely 7.6
associated with factors that may
9.3
vary over time, such as activities. Estonia
7.8
The strongest link found was
9.5
between happiness and time spent Romania
8.1
with family.21 This is consistent with
other research showing the 9.7
Greece (Epirus)
importance of family relationships 8.3
for children. There were also strong 9.7

Malta
links between happiness and the 8.5
frequency of playing outside.22 In
9.3
comparison, other factors such as Hungary
8.1
social media use and doing
8.9
housework were weakly, and less Norway
7.8
often significantly, linked with
happiness. Figure 12 shows the 9.5
Italy (Liguria)
differences in happiness between 8.5
children who played outside rarely 9.0
Belgium (Flanders)
and those who did so daily. These 7.9
differences are large – more than 9.5
1 point on a happiness scale of Spain (Catalonia)
8.5
0 to 10 (from least to most happy) –
9.6
in almost every country. Croatia
8.9
This example illustrates how
9.1
children’s activities can be linked to Switzerland
8.6
their subjective experiences. Of
0 1 2 3 4 5 6 7 8 9 10
course, children do not necessarily
have a free choice about how they Mean happiness score (0 to 10)
spend their time. In line with our Daily Rarely
framework, this will be affected by
the resources and relationships Worlds data shows that all of these
around them. For example, how factors are indeed relevant. Children Notes: Children were asked how often they
played outside. They were also asked to rate their
often children play outside may were more likely to play outside if happiness in the past two weeks on a scale from
depend on parenting styles, cultural their parents involved them in
0 to 10 (least to most happy). The figure
compares the mean happiness scores for children
differences, family economic making decisions about their lives, if who said that they played outside less than once
a week and those who said they did so every day.
circumstances, and safety and they lived in more affluent families All differences significant (p<0.01), except
facilities available in their local area. and if they lived in neighbourhoods Switzerland (p<0.05).
Source: Children’s Worlds survey, Wave 3,
Further analysis of the Children’s with good play facilities. 2017–2019, children aged about 10 years.
S E C T I O N 3 T
Spotlight 3 Screen time has a small negative influence,

and other activities matter more for well-being
The amount of time children spend online is increasing But does more screen time have a negative impact on
rapidly. In the United States, the proportion of children’s well-being? Despite public concern about
adolescents who say they are connected “almost this issue, the link appears to be weak.25 Robust
constantly” has increased from 24 per cent to 45 per studies suggest that moderate use is key.26 In these
cent in three years.23 An additional 44 per cent report studies, the highest mental well-being was observed
using the Internet several times a day. In 11 European not among those children who reported no screen
countries, the amount of time children spend online use, but among those who used screens for less than
almost doubled in less than a decade: from an hour 2 hours per day.
and a half to almost three hours daily (see Figure 13). It
Moderate use (between 30 minutes and 3 hours per
is understandable that parents and educators may be
day, depending on device and timing) was associated
concerned about the impact of new technologies on
with the highest mental well-being. Children who did
children’s well-being.
Children are online almost twice as long than a decade ago

Figure 13: Average duration of Internet use in minutes per day among 9- to 16-year-olds
250
200
150
Minutes/day
100
50
0
Germany
Italy
France
Poland
Lithuania
Czechia
Estonia
Portugal
Romania
Spain
Norway
2010 2018/19
Notes: Values have been calculated based on questions about how long children use the Internet a) on a normal weekday, and b) on a weekend
or holiday (approximately 1,000 cases per country). Only children who actively use the Internet were asked to estimate its duration so the
increase is not fuelled by increased access to the Internet. For full reports about the surveys see Livingstone et al. (2011), and Smahel et al. (2020).24
For details of the methodology see www.eukidsonline.net.
Source: EU Kids Online.
S E C T I O N 3 T
Children’s relationships
When asked about what matters to
their well-being, children emphasize
good-quality relationships.28 Survey
The impact of screen time is four times smaller than that of findings back this up, showing that
being bullied positive relationships with family,
Figure 14: Links between eight different activities and with peers and at school are linked
adolescent mental well-being
with higher well-being in one or
more dimensions.29
Regularly eating breakfast
Family relationships
Comparative data on children’s
Cycling
family relationships are scarce. The
Getting enough sleep
Health Behaviour in School-aged
Children (HBSC) survey, covering
Eating fruit
most European countries plus
Canada, asks children aged 11, 13
Technology use
and 15 years four questions about
how much they feel helped and
Binge drinking supported by their family: whether
their family tries to help them;
Wearing glasses whether they get the emotional
help and support they need from
Being bullied their family; whether they can talk
about problems with their family;
-0.25 -0.20 -0.15 -0.10 -0.05 0 0.05 0.10 0.15 0.20 0.25 and whether their family is willing
Effect of a given activity on adolescent well-being to help them make decisions.
Notes: The chart shows median standardized coefficients from the specification curve We averaged the responses to
analysis based on the UK Millennium Cohort Study. The sample included 5,926 girls and these four questions to create an
5,946 boys aged 13–15 and 10,605 primary caregivers. Technology use was measured
through five questions concerning TV use, electronic games, social media use, owning indicator of the quality of family
a computer and using the Internet at home.
Source: Orben, Amy and Andrew K. Przybylski, 'The association between adolescent
relationships, defining those
well-being and digital technology use', Nature Human Behaviour, vol. 3, no. 2, February children who scored below the
2019, pp. 173–182.
midpoint (which means they were
more likely, on average, to disagree
than agree) as having poor-quality
not use technology, as well as those who were very intensive users, had
relationships. Across 35 countries
lower well-being. The impact of technology has been shown to be time-
specific – stronger on school days than on weekends. This may reflect
and territories included in this
greater pressures on children during the days when they attend school. report, the percentage of children
who had poor-quality family
However, the impact of screen time should be put into perspective and relationships ranged from 6 per
assessed against other real-world benchmarks. An analysis of data from the
cent in Hungary, the Netherlands
United States and the United Kingdom suggests that the overall link
and Norway to over 30 per cent
between technology use and adolescent mental well-being is negative but
in Bulgaria.
small, explaining only 0.4 per cent of the differences in mental well-being.27
Many common activities that do not draw as much media attention – such
as eating breakfast, cycling or getting enough sleep – have a larger
association with adolescent mental well-being (see Figure 14). Among
negative factors, screen time had an association with adolescent well-being
four times less strong than that of being bullied.
S E C T I O N 3 T
In all countries, children who have less supportive families tend to have Figure 15 shows the link between
poorer emotional well-being the quality of family relationships
Figure 15: Emotional well-being of 15-year-olds according to the quality of and children’s emotional well-being.
their family relationships Emotional well-being is measured
by four questions about the
Germany frequency of children feeling low;
Netherlands feeling irritable or in a bad temper;
Belgium (Flemish) feeling nervous; and having difficulty
Spain
sleeping. In all countries, children
who reported having supportive
Austria
family relationships were also
Switzerland more likely to have good emotional
Norway well-being. The link between
Croatia supportive family relationships and
Luxembourg emotional well-being was much
stronger in some countries, like
Lithuania
Luxembourg and Portugal, than in
Canada others such as Iceland and Scotland
Slovenia (United Kingdom).
Finland
Peer relationships
Ireland
Peer relationships become
Portugal increasingly important for children’s
Iceland well-being as they grow up.30 There
Czechia is no good indicator of the overall
quality of peer relationships for all
Slovakia
41 countries. This is another major
UK (Wales)
evidence gap. The PISA study does,
Greenland however, contain information on
Estonia children’s experiences of being
Latvia bullied at school. Being bullied is
associated with children’s
Hungary
subjective well-being, particularly in
France
certain European countries.31
UK (England)
Belgium (French)
Notes: Excludes Denmark (no data), and England
UK (Scotland) (UK), Slovakia and Wales (UK) (over 10 per cent
missing data). An index was created from the
Sweden mean response to four statement-based questions:
(1) My family really tries to help me; (2) I get the
Malta emotional help and support I need from my family;
(3) I can talk about my problems with my family;
Romania and (4) My family is willing to help me make
decisions. Children were asked to indicate to what
Poland extent they agreed with each statement. The
percentages are of children who scored below the
Israel
midpoint on this index – i.e., were more likely, on
Greece average, to disagree than agree. The indicator of
emotional well-being is constructed from four
Italy questions about how often children felt low, felt
nervous, had difficulty sleeping, and felt irritable or
Bulgaria in a bad temper. Children are classified as having
low emotional well-being if they had more than one
0 10 20 30 40 50 60 70 80 90 100 of these experiences more than once a week. All
differences are significant (p<0.01) except England
Percentage with high emotional well-being (UK), Scotland (UK) and Greenland (p<0.05).
Source: Health Behaviour in School-aged Children
Children with low family support Children with high family support (HBSC) 2017/18.
S E C T I O N 3 T
Frequently bullied children are less satisfied with life As we showed in Report Card 15, it
Figure 16: Bullying frequency and life satisfaction of 15-year-olds is also linked to lower educational
performance in most countries.32
Netherlands Studies primarily from the United
Mexico States and the United Kingdom have
shown that being bullied has a
Romania
lasting negative impact even up to
Finland the age of 50, both on a person’s
Iceland social relationships and on their
mental and physical health.33
Switzerland
Figure 16 shows the relationship at
Croatia
15 years of age between frequent
Spain bullying – defined as experiencing
Lithuania at least one of six forms of bullying
France
at school at least a few times a
month34 – and life satisfaction. In all
Latvia
countries, children who had been
Estonia bullied frequently had lower mean
Portugal
life satisfaction scores than children
who had not. The gap in life
Austria
satisfaction between those who
Luxembourg had and had not been bullied often
Hungary was much bigger in some
countries, like the United States and
Slovakia
the United Kingdom, than in others
Sweden such as Bulgaria and Lithuania.
Greece
Italy
Czechia
Germany
Chile
United States
Ireland
Bulgaria
Poland
Note: Frequently bullied means that a child had
Slovenia experienced at least one of six forms of bullying
at least a few times a month, based on the
question ‘During the past 12 months, how often
Malta
have you had the following experiences in
school?’, with the possible experiences listed as:
United Kingdom
‘Other students left me out of things on purpose’;
‘Other students made fun of me’; ‘I was
Republic of Korea threatened by other students’; ‘Other students
took away or destroyed things that belonged to
Japan me’; ‘I got hit or pushed around by other
students’; and ‘Other students spread nasty
Turkey rumours about me’. Excludes Cyprus (data not
available) and Australia, Belgium, Canada,
0 10 20 30 40 50 60 70 80 90 100 Denmark, Israel, New Zealand and Norway
(question on life satisfaction not asked). All
Percentage with high life satisfaction
differences are significant (p<0.01).
Source: Programme for International Student
Frequently bullied Not frequently bullied Assessment (PISA) 2018.
S E C T I O N 3 T
Children with a stronger sense of school belonging do better at school and have higher life satisfaction
Figure 17: Differences in academic proficiency and in life satisfaction for 15-year-olds with a high and low sense
of belonging to school
Estonia Netherlands
Ireland Finland
Republic of Korea Romania
Finland Iceland
Netherlands Croatia
Japan Switzerland
Poland France
Germany Latvia
Sweden Spain
Slovenia Estonia
United Kingdom Portugal
France Sweden
Spain Lithuania
Austria Italy
Czechia Hungary
Switzerland Austria
Latvia Luxembourg
Iceland Ireland
Portugal Slovakia
United States Greece
Lithuania United States
Italy Czechia
Hungary Poland
Luxembourg Germany
Slovakia Slovenia
Malta Chile
Croatia Bulgaria
Greece Malta
Bulgaria United Kingdom
Chile Republic of Korea
Romania Japan
0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100
Percentage with proficiency in mathematics and reading Percentage with high life satisfaction
Low belonging High belonging Low belonging High belonging
Note: Excludes Cyprus (data not available) and Mexico and Turkey (more than 20 per cent of children aged 15 years not included in the survey). Data on reading
scores not available for Spain. Question on sense of belonging not asked in Israel. Question on life satisfaction not asked in Australia, Belgium, Canada, Denmark,
Israel, New Zealand and Norway. All proficiency differences are significant (p<0.01), except Bulgaria (ns). All life satisfaction differences are significant (p<0.01).
Source: Programme for International Student Assessment (PISA) 2018.
Connections with school differences in proficiency in reading Korea. The only exception to the
Children who have a strong sense of and mathematics and the general pattern was Romania, where
belonging to school tend to have differences in life satisfaction more children with a lower sense of
higher academic achievement. As between 15-year-olds who agreed belonging had met the basic
school is such a major part of most and did not agree with the proficiency standard. In all countries
children’s lives, it is reasonable to statement ‘I feel like I belong at for which data are available, more
suppose that aspects such as school’ across 33 rich countries. In children with a higher sense of
school belonging also contribute to all but one country, more of those school belonging tended also to
life satisfaction. Indeed, the PISA children with a greater sense of report high life satisfaction, although
study shows that, in most countries, belonging to school tended to have the difference was small in
school belonging is positively reached the basic level of Lithuania. In general, school
associated with academic proficiency in reading and belonging appeared to be more
achievement and with life mathematics. This pattern was strongly linked with life satisfaction
satisfaction. Figure 17 shows the particularly strong in the Republic of than with academic proficiency.
S E C T I O N 3 T
Spotlight 4 Protection and provision do not

suffice – children also need participation
It is important that children have the opportunity to provision. Yet, international monitoring of
express their views and are involved in decision- opportunities for participation is scarce compared
making. This is enshrined in Article 12 of the United with monitoring in relation to the other two themes.
Nations Convention on the Rights of the Child. Such Only some countries have data on this topic. In these
opportunities are vital for children’s well-being in the countries, children’s sense that their voices are being
present and for their development towards adulthood. heard varies widely. The proportion of children who
As children grow up, parents and other adults need to totally agree that their parents involve them in
adjust the balance between protecting children and decisions at home ranges from under half in regions
enabling them to have appropriate levels of autonomy. of Belgium and Italy, and in Switzerland, to two thirds
Children’s perceived satisfaction with their freedom in Romania. In Italy (Liguria) and the Republic of
contributes independently to their subjective well- Korea, fewer than two in five children totally agree
being, after taking account of their feelings of safety.35 that they are involved in decision-making at school,
compared with at least half of children in six other
Participation is one of the three Ps of the Convention
countries or territories.
on the Rights of the Child, along with protection and
Many children do not feel consulted about decisions at home and at school
Figure 18: Percentage of children who participate in decisions at home and at school
Involved in decisions at home Involved in decisions at school
Romania 67 Spain (Catalonia) 58
Estonia 66 UK (Wales) 57
Norway 65 Romania 56
Poland 65 Poland 53
Israel 64 Estonia 52
Malta 62 Malta 51
Croatia 59 Croatia 49
UK (Wales) 58 Switzerland 47
Finland 57 Finland 45
Hungary 53 Israel 44
Republic of Korea 51 Hungary 42
Greece (Epirus) 50 Norway 41
Spain (Catalonia) 50 Greece (Epirus) 41
Switzerland 48 Belgium (Flanders) 41
Italy (Liguria) 47 Republic of Korea 39
Belgium (Flanders) 46 Italy (Liguria) 38

0 20 40 60 80 0 20 40 60 80
Percentage of children who totally agreed Percentage of children who totally agreed
Note: Responses of 10-year-olds to closed questions with five responses to choose from: ‘I do not agree’; ‘I agree a little bit’; ‘I agree
somewhat’; ‘I agree a lot’; and ‘I totally agree’. Chart shows proportion who responded to each question, ‘I totally agree’.
Source: Children’s Worlds, 2017–2019.
S E C T I O N 4 T H E W O R L D A R O U N D T H E C H I L D
SECTION 4
THE WORLD AROUND THE CHILD
How do immediate surroundings differentiate
child well-being within countries
In this section, we look at ‘the

world around the child’: a range
of factors within the child’s
environment that can trickle down
Context
to influence their well-being. These
include the networks of the adults
closest to the child, household
Policies
resources and the quality of the
local neighbourhood.
Networks around the child

Resources
The networks of relations around
children affect their well-being even
though they do not always
Networks
experience them directly. In
contrast to the relationships
described in section 3, which
ationships
Rel referred only to relations involving
the child, networks refer to
connections established by the
Activities adults closest to the child –
especially by the parents. They
include: the family support
network, and parents’ relationships
with work and with their child’s
Outcomes school. Unfortunately, we are
unable to link these connections
with data on child well-being
outcomes as information on
networks is not available within the
The world of the child same international surveys.
Support for parents

The world around the child
Families that lack social support
The world at large networks may find it more difficult
to cope with adversity. This can
negatively affect children’s well-
Who can parents count on if they need help to look after their children?
Figure 19: Percentage of parents able to seek support from a family member, friend or service provider
Bulgaria
Greece
Lithuania
Poland
Slovenia
Austria
Cyprus
Czechia
Estonia
Finland
Hungary
Ireland
Slovakia
Sweden
Portugal
Denmark
Latvia
Spain
Germany
Italy
United Kingdom
Croatia
Malta
Netherlands
Romania
Turkey
France
Belgium
Luxembourg
0 10 20 30 40 50 60 70 80 90 100
Family Friends Service Nobody
Note: Data were only available for the 27 EU countries, plus Turkey and the United Kingdom. Original question: ‘From whom would you get support if you needed
help in looking after your children? Choose the most important source.’ Ranked by the proportion of parents who said they could count on help from either a
family member or a friend.
Source: European Quality of Life Survey (EQLS) 2016.
being. That is why the presence of member, friend or service provider would be unable to seek help from
informal support for families through if they needed help to look after either of these sources. This ranges
social networks is often seen as a their children. The chart is ranked from less than 1 in every 100
protective factor for children’s by the proportion of parents who parents in Poland, Bulgaria, Greece,
healthy development.36 said that they would be able to Slovenia and Lithuania to more than
seek support from either a family 10 in every 100 parents in
Figure 19 shows the proportion of
member or a friend. Only a small Luxembourg and Belgium.
parents who say that they would be
proportion of parents said they
able to seek support from a family
Inability to fulfil family responsibilities relates to long working hours

Figure 20: Percentage of employees struggling to balance work and family, and average working
hours in European countries
TR
70
R=0.84
Percentage struggling to fulfil family responsibilities (2016)
60
CZ
50 GR HUPL
LV
ES LT
BE EE SI
40
UK
IT FR PT
LU SK
DE
30 AT
IE
NL FI
SE
DK
20
30 35 40 45 50
Average weekly hours worked in main job (2016)
Note: ‘Average weekly hours worked in main job’ includes any paid or unpaid overtime. ‘Percentage struggling to fulfil family responsibilities’ refers to the
percentage of employees who have chosen the option ‘At least several times a month’ under ‘It has been difficult to fulfil family responsibilities because of time
spent on job’. Work–family balance data only available for the 27 EU countries, plus Turkey and the United Kingdom. Data on long working hours unavailable for
Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on work–family balance: European Quality of Life Survey (EQLS) 2016. Data on long working hours: OECD (2017) based on Labour Market Statistics,
2016 or latest available year.
Work pressure on parents individual and their relationships work-related stress can reduce the
Although not working due to with people around them. A culture time and energy parents have to
involuntary unemployment is of regularly working overtime leads interact with their children. And,
economically and socially corrosive, to expectations that all employees indeed, it is in those countries with
overworking is not conducive to (whether parents or not) will long working hours that more
well-being either. It can damage the prioritize work. Long hours and employees find it difficult to fulfil
family responsibilities because of a car? Can the family afford to take is linked to higher rates of
time spent at work (see Figure 20). holidays? A lack of resources can overweight and obesity through a
On average across the 24 countries affect children through various variety of mechanisms, including
in this figure, 39 per cent of routes. For example, research access to different types of food
employees found it difficult to fulfil indicates that low family affluence and patterns of physical activity.37
family responsibilities at least several
times per month. The proportion of Parents’ rating of their relationships with their child’s school in
employees who struggle to balance European countries
work and family varies across Figure 21: What do parents think about their relationship with the staff
countries, ranging from one quarter at their child’s school?
of respondents in Denmark to more
than two thirds of those in Turkey. Bulgaria 8.3
Malta 8.3
The relationship between parents
Ireland 8.3
and schools
Finland 8.2
Parents’ relationships with their
Denmark 8.2
child’s school is another important
aspect of the Networks around Estonia 8.1
the child. Lithuania 8.1
Poland 8.1
Figure 21 shows a rating on a scale
from 1 to 10 (from least to most Hungary 7.9
satisfied) that averaged the answers Slovenia 7.8

to three questions about whether Sweden 7.8
parents feel that education United Kingdom 7.7
professionals consult them, are Latvia 7.7
attentive and treat all people equally.
Germany 7.7
Satisfaction with these relationships
Croatia 7.6
ranges from 6.8 in Turkey to 8.3 in
Spain 7.6
Bulgaria, Ireland and Malta.
Austria 7.6
Resources available to children
Netherlands 7.6
A good childhood requires
Romania 7.6
sufficient resources to support the
Luxembourg 7.6
child both within the household and
Slovakia 7.5
within the neighbourhood.
Czechia 7.5
Household resources
France 7.4
The material resources available to Belgium 7.4
children in their homes can affect
Portugal 7.3
various aspects of their well-being,
Cyprus 7.2
including their cognitive
development, physical health and Greece 7.2
subjective well-being. Household Italy 7.0
resources can mean resources Turkey 6.8
individual to the child. For example, 1 2 3 4 5 6 7 8 9 10
does the child have a computer? Parents’ rating of relationship with school staff (1–10)
Does the child have her/his own
bedroom? Or the term can refer Note: Data only available for the 27 EU countries, plus Turkey and the United Kingdom. The chart presents
more broadly to resources for the an average of parents’ answers to three questions about satisfaction with: (1) personal attention given by
education professionals; (2) being informed or consulted about their child’s education; and (3) all people
entire family. Does the family own being treated equally by education services in the area.
Source: European Quality of Life Survey (EQLS) 2016.
Children living in households without educational books A lack of resources can also be a
have lower levels of academic proficiency barrier to academic achievement.
Figure 22: Percentage of 15-year-olds who have reached basic As an example, Figure 22 shows the
proficiency in reading and mathematics, according to whether proportion of children with basic
or not there were books at home to help with schoolwork
proficiency in reading and
mathematics at age 15 for two
Estonia
groups – those who had books at
Finland
home to help with schoolwork and
Ireland
those who did not. The proficiency
Japan
gap between the groups is quite
Netherlands
substantial in most countries.
Republic of Korea
Canada Neighbourhoods
Poland From a child’s viewpoint, the
Denmark environment starts in the child’s
Slovenia neighbourhood, particularly in those
Germany places in which they spend time
France and play. There are scarce
Belgium comparative data on this topic
Norway drawn from children themselves,
Czechia but the Children’s Worlds survey
Switzerland gathers children’s views on their
Sweden neighbourhoods for a selection of
United Kingdom countries. The proportion of
New Zealand children who totally agreed that
Australia they have local places to play
Latvia ranged from one third in the
Hungary Republic of Korea to two thirds in
Portugal Estonia and Switzerland.
Austria
Figure 23 shows that children who
United States
live in neighbourhoods with places
Lithuania
to play tend to be happier than
Italy
those who do not. In Estonia and
Iceland
Switzerland, 7 in 10 children totally
Slovakia
agreed when asked whether their
Luxembourg
neighbourhood had enough places
Croatia
to play. In the Republic of Korea,
Malta
only one third of children did so.
Israel
Asked about their happiness, these
Greece
same children expressed greater
Bulgaria
happiness than those who had said
Romania
that their neighbourhood lacked
Chile
such amenities. The difference in
0 10 20 30 40 50 60 70 80 90 100
mean happiness scores between
Percentage proficient in reading and mathematics the two groups was more than one
No educational books at home Educational books at home point (on an 11-point scale) in the
Republic of Korea and Israel.
Notes: Children were asked whether or not there were books at home to help with schoolwork. The
measure of academic proficiency is the one introduced in section 3 (see Figure 10). All differences
between the two groups were significant at p<0.01 except Israel, significant at p<0.05.
Source: Programme for International Student Assessment (PISA) 2018.
Children who live in neighbourhoods with enough places to play are happier
Figure 23: The extent to which children agreed that they have enough places to play in their
neighbourhood, and mean levels of happiness for children who totally agreed and for those who did not
Are there enough places to play? Happiness
9.2
Estonia 70
8.2
9.0
Switzerland 70
8.3
9.5
Croatia 65
9.0
9.2
Hungary 65
8.5
9.1
Poland 63
8.6
9.0
Israel 61
7.9
9.6
Greece (Epirus) 60
9.0
9.4
Spain (Catalonia) 58
8.9
9.0
Belgium (Flanders) 57
8.3
9.0
Finland 57
8.0
8.9
Germany 53
8.1
9.0
Norway 53
8.0
9.1
UK (Wales) 50
8.3
9.4
Italy (Liguria) 42
8.8
9.5
Malta 40
9.0
9.6
Romania 36
9.1
9.4
8.2
100 90 80 70 60 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10
Percentage of children who totally agreed Mean happiness (0 to 10)
Totally agree Did not totally agree
Notes: Data relate to children aged 10 years. The first chart shows responses to the statement ‘In my area, there are enough places to play or have a good time’.
The second chart compares mean scores for happiness in the last two weeks for children who totally agreed with the statement about having enough places to
play and those who did not. All differences significant at 99% level.
Source: Children’s Worlds survey, Wave 3, 2017–2019.
S E C T I O N 5 T H E W O R L D A T L A R G E
SECTION 5
THE WORLD AT LARGE
Why do some countries have higher child
well-being than others?
The world of the child and the

world around the child allowed us
to see how well-being varies
between children within the same
Context
country. Yet, children’s experience
of childhood does not exist in a
social vacuum – it is rooted in the
Policies
society in which they live.
Therefore, we now broaden our
focus to the world at large,
Resources understood as ‘national conditions
that support child well-being’ – the
outermost levels of our framework
Networks – to see why some countries have
higher child well-being than others.
In the next circle outwards (Policies),

ationships
Rel we look at the results of a country’s
social, education and health policies
in providing services to children. In
Activities the outermost circle (Context), we
focus on general quality of life issues
such as air quality and levels of social
support. Comparing policies and
context between countries is
fundamental to understanding why
Outcomes
their child well-being outcomes differ.
Policies
The penultimate circle (Policies),
refers to benefits and services
delivered to children and their
The world around the child families that can influence current
and future child well-being. We
The world at large focus on three policy areas – social,
education and health policy – which
are interrelated and may influence
Leave reserved for fathers makes up one tenth of parental leave in rich countries
Figure 24: Weeks of leave available to mothers and reserved for fathers in 2018, in full rate equivalent
100
90
Weeks of full pay equivalent
80
70
60
50
40 Average: 36 weeks of full pay
30
20
10
97.1
86.4
71.7
69.2
66.1
66.0
55.9
53.1
52.8
52.4
52.3
48.3
47.5
46.0
45.4
45.3
44.6
43.6
40.6
32.9
31.0
27.6
26.6
26.6
26.0
23.4
21.7
20.3
18.0
16.4
15.7
15.0
15.0
13.0
12.1
11.7
8.6
8.4
8.2
7.5
0
0
United States
Romania
Estonia
Bulgaria
Hungary
Japan
Lithuania
Austria
Slovakia
Croatia
Latvia
Norway
Slovenia
Germany
Czechia
Finland
Sweden
Luxembourg
Poland
Republic of Korea
Portugal
Chile
Denmark
Iceland
Canada
Italy
France
Greece
Spain
Belgium
Netherlands
Malta
Cyprus
Israel
Mexico
United Kingdom
Turkey
Australia
New Zealand
Switzerland
Ireland
United States
Leave available to mothers Leave reserved for fathers
Note: The medium blue bar (leave available to mothers) shows a combination of maternity leave and paid parental leave that can be used by the mother and is not
reserved for the father. The dark blue bar shows the leave reserved for fathers on a ‘use-it-or-lose-it’ basis. Number of weeks of maternal and paternal leave each refer
to the full-rate equivalent. For example, if a mother is entitled to 20 weeks of maternity leave at 50 per cent of her usual salary, her full-rate equivalent leave is 10 weeks.
Source: Organisation for Economic Co-operation and Development (OECD) Family Database.
one another. For example, while Parental leave father bonding. It also promotes
low birthweight is treated as an Family policies matter for ethical, family stability, as men who take
indicator of health policy, it is also social, medical, educational, parental leave are more likely to
influenced by policies aimed at economic and demographic remain engaged fathers many years
tackling poverty. reasons. Maternity leave facilitates after the leave is over.39
bonding between the child and
Social policies Early adopters of new paternity
mother. It also allows women to
Governments can use social policy leave entitlements can face
prepare for childbirth and to
to support children’s well-being. professional and cultural barriers
recover from pregnancy and it
One way that they can do this is that prevent them from staying
facilitates breastfeeding. A period
through family policies that help with their child.40 To encourage
of well-paid, job-protected leave
parents to raise their children. Here uptake, 35 out of the 41 countries
from work helps eligible employees
we look at one such policy, parental included in this report have
to maintain their income and their
leave. We also look at the rate of introduced leave reserved for
attachment to the labour market.
relative child poverty, which reflects fathers on a ‘use-it-or-lose-it’ basis.
Yet, leave entitlements that are
social policy in terms of the For example, Iceland has rewritten
inflexible, underpaid or have a
distribution of income among its family law to reflect the child’s
gender imbalance can have a
families with children after taxes right to access both parents –
negative effect on the work
and government transfers. starting with each of them taking at
prospects of women and, to a
least three months of leave during
lesser extent, men.38
the period when the child is an
If taken, leave reserved for fathers infant.41 Figure 24 shows statutory
gives children access to both parental leave entitlements in terms
parents, which is one of their rights of the equivalent number of weeks
under the Convention on the Rights of pay at the full rate. There is wide
of the Child, and supports child– variation across the countries,
In almost half of rich countries, more than one in five children lives in poverty
Figure 25: Percentage of children living in households with income below 60 per
cent of the national median income in 2008, 2014 and 2018
40
35
30
Percentage of children in poverty
25
Average: 20%
20
15
10
5
20.5
20.6
21.0
21.4
22.7
22.7
23.9
24.1
24.4
26.2
26.6
26.8
27.2
27.6
30.0
32.0
32.0
33.0
10.4
11.0
11.0
11.1
11.5
11.7
13.0
13.1
13.2
13.8
14.5
15.2
15.8
17.3
17.5
17.5
18.8
19.0
19.0
19.2
19.3
19.7
19.9
0
Portugal
Iceland
Czechia
Denmark
Finland
Republic of Korea
Slovenia
Poland
Netherlands
Norway
Hungary
Germany
Estonia
Ireland
Cyprus
Australia
Latvia
Japan
Switzerland
Austria
Sweden
Croatia
France
Slovakia
Belgium
Canada
Malta
Greece
Luxembourg
Lithuania
United Kingdom
New Zealand
Italy
Bulgaria
Spain
Chile
Mexico
United States
Israel
Romania
Turkey
2018 (or latest available) 2014 2008
Notes: Percentage of children living in households with post-tax, post-transfer income – adjusted for family size and composition – below 60 per cent of the
national median income. Equivalence scale: first adult in a household counted as 1; each other household member aged 14 years or above counts as 0.5 person;
each household member aged 13 years or below counts as 0.3 person. Data for 2018 except for Canada, Chile, New Zealand, Turkey (2017); Australia, Iceland,
Israel, United States (2016); and Japan (2015).
Source: EU Statistics on Income and Living Conditions, HILDA wave 17 (Australia), ENIGH, Household Economic Survey (New Zealand) estimates taken from
Perry, B (2017), Canadian Income Survey (estimates from L. Wollf and D. Fox), Survey of Living Conditions (Japan) estimates taken from A. Abe, Luxembourg
Income Study (Chile, Israel, Mexico, United States), combined data of Household Income and Expenditure Survey and Farm Household Economy Survey (Republic
of Korea), courtesy of Statistics Korea and the Korean Committee for UNICEF.
ranging from no statutory leave in stepfamilies and two-household Spain introduced parental leave for
the United States to more than one families, where children alternate both parents of same-sex couples.42
year of leave in several countries. their time between the homes of
Child poverty
On average, only 10 per cent of the both parents; a higher incidence of
Children often pay a high price for
total duration of leave is reserved one or both parents spending
growing up in poverty. Children in
for fathers. lengthy periods of time working
poorer families tend to have worse
abroad; and new rights for same-
In many of the countries we cover cognitive and socio-emotional
sex partnerships. These
in this report, family formations are development, and worse health as
developments are gradually being
becoming increasingly diverse. This adults.43 Relative child poverty is
reflected in family policies. For
diversity often includes increasing defined here as children who live in
instance, in 2019, Canada and
proportions of lone-parent families, households which, taking account
of household size and composition, by country from 10 per cent in spending on families with children
fall below 60 per cent of the Iceland to 33 per cent in Turkey in Nordic countries in comparison
national median per capita income. (see Figure 25). Yet, as we will with the post-communist countries
This measure shows how effective show in the economic context (see Figure 26). However, it is not
a national system of taxes and subsection, the countries with the only a matter of how much is
transfers is in preventing families lowest relative child poverty spent, but also how it is spent.
with children from falling into (Iceland, Czechia and Denmark) Tax breaks run the risk of favouring
poverty. In this sense, we treat only partially overlap with the more middle-class and affluent
national child poverty as an countries with the lowest income families. Conversely, high-quality
outcome of multiple social policies. inequality (Slovakia, Slovenia and public services, if sufficiently
Czechia) (see Figure 35). This is accessible and affordable, can
In 2018, the average relative child
partly due to different demographic support all children and their
poverty rate across the 41 countries
structures as well as higher families.
was 20 per cent. This rate ranged
On average, rich countries spend 2.4 per cent of gross domestic product (GDP) on families –
services account for half of this sum
Figure 26: Public spending on cash transfers, services and tax breaks for families in 2015
4.0
3.5
3.0
Percentage of GDP
2.5 Average: 2.4% GDP
2.0
1.5
1.0
0.5
0
France
Sweden
Iceland
Norway
Luxembourg
Estonia
Ireland
Netherlands
Poland
Slovenia
Lithuania
Chile
Canada
Japan
Portugal
Republic of Korea
Spain
Greece
United Kingdom
Hungary
Denmark
New Zealand
Belgium
Finland
Germany
Czechia
Austria
Italy
Slovakia
Australia
Switzerland
Israel
Latvia
United States
Mexico
Turkey
Cash Services Tax breaks
Source: Organisation for Economic Co-operation and Development (OECD) Social Expenditure Database, 2015.
Spotlight 5 Poor children in the United Kingdom

are more likely to be obese and have low skills
Poverty is not just a monetary circumstance. It spills To learn whether these patterns change with time, we
over into other aspects of children’s lives. We looked grouped 14-year-old children into categories according
at its consequences for depression, obesity and to how often they had been in poverty at six points in
vocabulary, corresponding to the mental well-being, time during their childhood (at the age of 9 months
physical health and skills dimensions at the heart of and then at 3, 5, 7, 11 and 14 years of age). Children
the well-being framework (see Box 1). We used data who had lived in more persistent poverty had poorer
from a UK study that followed thousands of children vocabulary skills (see Figure 27). The effect was
born in the early 2000s for almost two decades. cumulative: the more often children had experienced
poverty, the more likely they were to have a poor
We divided households with children into five income
vocabulary. This probably reflects the fact that new
groups. At 14 years of age, children in the poorest
skills build on existing skills. Children who had
group were 2.6 times more likely to have a poor
experienced poverty were also significantly more likely
vocabulary and 1.8 times more likely to be obese than
to be obese and slightly more likely to be depressed
children in the richest group. The link between
at 14 years of age. Yet, in the latter case, we found
income and depression was less clear.
less evidence of a cumulative effect of poverty.
Persistent poverty impedes children’s development

Figure 27: History of household income poverty and three child outcomes at
14 years of age in the United Kingdom: vocabulary, obesity and depression
30
Percentage of children aged 14 years
25
20
15
10
5
22.2
19.6
23.2
23.5
14.4
20.4
10.0
14.4
15.2
15.7
13.0
19.2
0
Low word score Obese Depressed
Number of points in time between infancy and age 14 years when a child lived in poverty
None Once 2 to 4 times 5 or 6 times
Notes: Children aged 14 years in the United Kingdom. The word score is based on a 20-item test of word recognition. Obesity is defined as
a BMI above 30. Depression is defined as a score of 12 or more using the 13-item Moods and Feelings Questionnaire. The analysis takes
account of survey design and weightings. The values shown in the charts are marginal effects after controlling for age (tenths of a year),
gender and ethnic group. Poverty is defined as having an equivalized household income below 60 per cent of the national median income.
Source: Millennium Cohort Study, United Kingdom, 2000–2016.
What percentage of children have experienced organized learning before starting school?
Figure 28: Children with experience of organized learning one year before starting school
100
Percentage of children one year before school
Average: 94.7%
90
80
70
60
50
40
30
20
10
99.9
99.9
99.9
99.9
99.8
99.7
99.4
99.3
99.3
99.1
99.1
99.1
99.0
98.8
98.4
98.2
98.1
97.0
96.2
96.2
95.9
95.4
95.4
94.6
94.2
94.1
93.9
93.7
93.6
93.2
93.2
92.7
91.2
91.1
89.4
87.1
86.4
83.4
82.3
67.6
100
0
Austria
United Kingdom
Ireland
Sweden
Lithuania
France
Netherlands
Switzerland
Portugal
Malta
Poland
Finland
Israel
Mexico
Germany
Belgium
Luxembourg
Latvia
Canada
Norway
New Zealand
Republic of Korea
Bulgaria
Croatia
Cyprus
Iceland
Slovenia
Italy
Denmark
Chile
Spain
Estonia
Greece
United States
Japan
Czechia
Hungary
Australia
Romania
Slovakia
Turkey
2017 (or latest available) 2010
Notes: Data for the blue bars are from 2017 or the latest year available (2016 for Bulgaria, Canada, Croatia, Malta, Romania, United States; 2015 for Cyprus; 2013
for Japan – figure from Report Card 15). Percentage of children with experience of organized learning one year before starting school is an official Sustainable
Development Goal indicator.
Source: United Nations Educational, Scientific and Cultural Organization (UNESCO). Data for New Zealand from United Nations Statistics Division.
Education policies figure is more than 15 per cent: 70 per cent of children under
Preschool participation Romania (17 per cent), Slovakia (18 3 years of age use organized
Public provision of high-quality per cent) and Turkey (32 per cent). childcare, 6 per cent of parents said
childcare helps to reduce socio- that they have unmet childcare
Enrolment rates are substantially
economic disadvantage before needs. This is almost the same
lower for younger children. Across
children start formal schooling.44 percentage as in Czechia, where
Europe (the 27 EU countries, plus
It can also provide a stimulating only 5 per cent of children attend
Iceland, Norway, Switzerland and
social and learning environment. organized childcare. Across the
the United Kingdom), 15 per cent
Ensuring that all children have European countries, about one half
of parents with children under 3
access to organized learning at of parents of children under 4 years
years of age would like to use day
least one year before starting of age declared no need for
care but cannot do so. The main
school is one of the Sustainable childcare. This reflects, in part,
obstacles include affordability and
Development Goals. Figure 28 cultural differences in childcare
availability of places. However,
shows that in 17 countries more styles and preferences.
rates of participation and unmet
than 5 per cent of children are not childcare needs do not necessarily
in preschool. In three countries, the go together. In Denmark, where
In 22 European countries, more than 1 in 10 parents has an unmet childcare need

Figure 29: Unmet needs among parents of children under 3 years of age in European countries
35
30
25
Percentage of parents
20
Average: 14.5%
15
10
5
2.0
20.2
20.9
21.9
22.6
24.3
28.5
33.0
10.7
10.7
10.8
10.9
11.3
11.3
12.9
13.1
14.7
15.2
15.3
15.9
16.8
16.9
17.4
4.6
5.9
6.5
8.2
8.8
9.1
0
Bulgaria
Hungary
Czechia
Denmark
Sweden
Italy
Lithuania
Switzerland
Belgium
Romania
Croatia
Estonia
Austria
Finland
Luxembourg
Portugal
Germany
Latvia
Poland
Cyprus
France
Greece
Slovenia
Norway
Ireland
Slovakia
Netherlands
United Kingdom
Spain
Notes: An ‘unmet need’ for childcare is assessed based on the question ‘Would you like to make (more) use of childcare centres?’. No unmet needs data for Iceland
and Malta.
Source: EU Statistics on Income and Living Conditions (EU-SILC) survey 2016 (for Switzerland, the latest available data were from 2014).
Countries with high childcare satisfaction have high enrolment and affordable prices
Figure 30: Satisfaction with childcare mapped against enrolment and affordability
9 9
8 MT 8 MT
FI FI
AT LU SE SE AT LU
Satisfaction with childcare
Satisfaction with childcare
DK DK
DE NL NL DE
EE SI R=0.39 EE SI
HU HU
7 CZ 7 CZ LT
LT
BE PL BE
PL
ES ES
FR FR
SK CY LV SK LV
GB CY
BG HR GB PT BG PT HR TR
IE IE
6 IT 6 IT
RO RO
R=-0.56
GR GR
5 5
4 4
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80
Percentage of children aged 0–3 years in preschool Percentage of parents struggling with childcare costs
Notes: Satisfaction with childcare (scale from 0 to 10, from least to most satisfied) asked only to parents of a child below 12 years of age who had received formal
childcare in the past 12 months. Data on child enrolment are Eurostat estimates based on information from the EU Statistics on Income and Living Conditions
(EU-SILC) survey. No data on child enrolment for Turkey. Data for Iceland are from 2015.
Source: European Quality of Life Survey (EQLS) 2016; Eurostat, ‘Children in Formal Childcare or Education by Age Group and Duration – % over the Population of
Each Age Group – EU-SILC Survey’, <https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_caindformal&lang=en>, accessed 24 February 2020.
At the country level, the preschool Young people not in education, Health policies
participation rate is positively employment or training Vaccines
correlated with service satisfaction Young people who are disengaged Some achievements in child health
(see Figure 30). This may reflect the from both education and the labour can lead to complacency. One
fact that parents are more likely to market may face a more difficult example is the herd immunity to
use preschool if they have a good start to adult life. One of the measles established by high
opinion of the service. High cost indicators used to monitor this immunization coverage. In some
may be a deterrent. On average, issue is the proportion of young regions where measles epidemics
across the 29 European countries people aged 15–19 years who are had been consigned to the past,
(the 27 EU countries, plus Turkey not in education, employment or immunization rates have dropped,
and the United Kingdom), 40 per training (NEET). Between 2010 and
putting children once again at risk.
cent of parents who had used 2018, the NEET rate improved in
In recent years, some of the
preschool had found it difficult to 30 out of 37 countries – largely
world’s richest countries, including
cover its cost. Between countries, reflecting the subsiding effects of
Czechia, Greece and the United
the proportion of parents who had the 2008 economic crisis. However,
Kingdom, have lost their measles
struggled to pay childcare costs in Turkey, Mexico, Bulgaria, Chile
elimination status.45
ranges from 3 per cent in Sweden and Italy, more than 1 in 10 young
to 78 per cent in Turkey. people are still receiving neither an Immunization rates are typically
education nor work experience. used as measures of the availability
In five rich countries, more than 1 in 10 young people are out of school and work
Figure 31: Percentage of all young people aged 15–19 years not in education, employment or training (NEET)
30
25
Percentage of 15- to 19-year-olds
20
15
10
Average: 6%
5
11.0
11.4
11.8
13.7
15.3
2.4
2.5
2.6
2.9
3.3
3.4
3.5
3.5
3.9
3.9
4.0
4.1
4.6
5.1
5.3
5.3
5.6
5.9
6.0
6.3
6.8
6.8
6.8
7.1
7.1
8.1
8.5
8.7
8.9
8.9
9.0
9.2
1.5
1.9
0
Luxembourg
Slovenia
Czechia
Norway
Lithuania
Latvia
Netherlands
Germany
Denmark
Poland
Belgium
Iceland
Portugal
Switzerland
Finland
New Zealand
Australia
Austria
Slovakia
Canada
Ireland
Malta
France
Hungary
Sweden
Cyprus
United States
Greece
Croatia
Spain
Israel
United Kingdom
Estonia
Romania
Italy
Chile
Bulgaria
Mexico
Turkey
2018 2010
Note: Data for the blue bars are from 2018 or the latest year available (2015 for Chile).
Source: Data for Bulgaria, Croatia, Cyprus, Malta and Romania: Eurostat 2018. Data for remaining countries: Organisation for Economic Co-operation and
Development (OECD) Family Database Table PF2.1.B (updated 26 October 2017).
and affordability of preventive importance of cross-country rate has dropped between 2010
health services for children. Yet, collaboration to keep children free and 2018 in 14 out of the 35 rich
with the rise of anti-vaccination of this preventable disease. countries for which comparable
movements, some immunization data are available (see Figure 32).
Therefore, of all of the important
rates have also become measures
child vaccines, including polio and Low birthweight
of the efficacy of public health
DPT (diphtheria-pertussis-tetanus), The second health policy indicator
communication. They indicate
we focus on the measles vaccine.47 is the proportion of babies who
whether the general public is well-
Across 40 countries (all except weigh less than 2,500 grams at
informed about immunization or
Ireland), the measles immunization birth. Birthweight is considered the
whether false information is putting
rate averages 91 per cent, ranging most important predictor of an
children at risk. Additionally, 1 in 10
from 80 per cent in France to infant’s chances of survival and
cases of measles is contracted
99 per cent in Hungary, Mexico and growth.48 At the policy level,
while travelling abroad or while in
the Republic of Korea. This range of birthweight is treated as an
contact, in one’s own country, with
values is larger than for DPT indicator of the quality of care
someone from another country.46
vaccines and therefore the measles available during pregnancy. It is also
This shows that high immunization
immunization rate meets our related to the health, age and
coverage at the country level is
variability criterion for data usage nutrition of the mother, and whether
insufficient and emphasizes the
(see Spotlight 1). Moreover, this there was substance abuse during
Measles immunization dropped in 14 rich countries from 2010 to 2018

Figure 32: Percentage of children who received the second dose of the measles vaccine
100
90 Average: 91.1%
80
Percentage of children
70
60
50
40
30
20
10
99
99
99
97
96
96
95
95
95
95
94
94
94
94
93
93
93
93
93
93
92
92
90
90
90
89
89
89
88
88
88
87
87
87
85
84
84
83
81
80
0
Mexico
Slovakia
Republic of Korea
Hungary
Portugal
Israel
Sweden
Malta
Croatia
Slovenia
Iceland
United States
Spain
Latvia
Norway
Bulgaria
Japan
Germany
Finland
Chile
Australia
Poland
Lithuania
New Zealand
Luxembourg
Denmark
Switzerland
Netherlands
Italy
Turkey
United Kingdom
Estonia
Cyprus
Canada
Belgium
Czechia
Austria
Greece
Romania
France
2018 2010
Note: Percentage of children who received the measles vaccine second dose (MCV2) administered as per the national schedule. Ireland is omitted as no 2018 data
were available for MCV2.
Source: WHO/UNICEF estimates for 2018. See: World Health Organization, ‘Immunization, Vaccines and Biologicals: Data, statistics and graphics’,
<www.who.int/immunization/monitoring_surveillance/data/en>, accessed 24 February 2020.
One in 15 infants born in rich countries is underweight at birth

Figure 33: Number of live births weighing less than 2,500 grams as a percentage of total live births
12
10
Percentage of live births
8
Average: 6.7%
8.9
9.3
9.3
9.4
9.9
3.8
4.2
4.2
4.4
4.5
4.6
4.9
4.9
5.2
5.7
5.7
5.9
6.0
6.0
6.2
6.3
6.3
6.4
6.4
6.5
6.5
6.6
6.6
6.7
6.9
7.4
7.4
7.5
7.5
7.6
7.7
7.8
8.1
8.1
8.3
8.3
0
Iceland
Finland
Estonia
Latvia
Sweden
Norway
Denmark
Lithuania
Croatia
Ireland
Poland
Netherlands
Mexico
New Zealand
Republic of Korea
Luxembourg
Chile
Austria
Switzerland
Australia
Canada
Germany
Slovenia
Belgium
United Kingdom
Czechia
Italy
Malta
Slovakia
France
Israel
Spain
Turkey
Romania
Hungary
United States
Portugal
Greece
Bulgaria
Japan
Cyprus
2017 (or latest available) 2010
Note: Data for the blue bars are from 2017 or the latest year available (2016 for Australia, Belgium, Chile, France, Sweden; 2015 for Romania; 2013 for Germany).
Starting year data are from 2010, except for Turkey (2012) and Cyprus (2007).
Source: Data for Bulgaria, Croatia, Cyprus and Romania are from: World Health Organization Regional Office for Europe, European Health Information Gateway,
‘% of Live Births Weighting 2500 g or More’, <https://gateway.euro.who.int/en/indicators/hfa_600-7100-of-live-births-weighing-2500-g-or-more>, accessed
7 January 2020. Data for remaining countries are from: Organisation for Economic Co-operation and Development, OECD.Stat, ‘Health Status: Key indicators’,
<https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT>, accessed 7 January 2020.
the pregnancy. Based on the above may affect children directly. For strong social fabric contribute to a
threshold, the average percentage example, air pollution can damage good life for all and constitute a
of live births that are underweight their health. Or the components foundation for the well-being of
across the 41 countries is close to may affect them indirectly. For current and future generations.
7 per cent. This proportion has example, parental unemployment
Economic context
remained stable over the last can put a strain on household
decade (see Figure 33). There are resources and relationships, which Jobs
substantial differences between can, in turn, affect child well-being. As we’ve seen in the earlier section
countries in the proportion of In this section, we deliberately about work pressure on parents,
underweight live births, ranging choose broad indicators that apply employment does not always
from 4 per cent in Iceland to almost to the whole population for two translate into well-being. However,
10 per cent in Cyprus. reasons. First, they minimize the there are good reasons to include it
number of people missing from the as a key factor. Work can provide
Context the resources, networks, skills and
data, including marginalized
The national context that supports children, who are often invisible in sense of meaning that facilitate
child well-being includes economic, surveys. Second, a clean well-being. Unemployment has
social and environmental environment, healthy economy and been found to be one of the most
components. These components important and persistent factors
Unemployment still has not dropped below its pre-crisis level in all countries
Figure 34: Unemployment rates from 2007 to 2019
20
18
Unemployed as a percentage of active population
16
14
12
10
Average: 6%
6
11.9
14.7
18.1
2.4
2.5
3.0
3.2
3.3
3.4
3.5
3.7
3.8
3.8
3.9
3.9
4.0
4.2
4.6
4.6
4.8
4.8
4.8
4.9
5.3
5.3
5.4
5.5
5.9
6.1
6.1
6.4
6.4
6.6
6.8
7.3
7.4
7.8
7.9
8.2
9.1
9.2
0
Czechia
Iceland
Belgium
Japan
Germany
Poland
Mexico
Hungary
Republic of Korea
Norway
Netherlands
United Kingdom
United States
Israel
Romania
Malta
Austria
New Zealand
Bulgaria
Denmark
Switzerland
Ireland
Australia
Luxembourg
Slovenia
Canada
Portugal
Estonia
Slovakia
Lithuania
Sweden
Finland
Chile
Croatia
Cyprus
Latvia
France
Italy
Turkey
Spain
Greece
2019 2007
Note: Unemployment as a percentage of the total labour force, modelled on International Labour Organization estimates. Unemployment refers to the share of the
labour force (aged 15–64 years) who would like to work and have taken active steps to find employment – that is, those who are without work but available for and
seeking employment.
Source: World Development Indicators 2019.
affecting adult well-being.49 As a making a judgement on choices Income

consequence, it is likely to affect such as parents who have decided We use the gross national income
family relationships and child well- to stay at home to look after their (GNI) per capita as a proxy for a
being. This issue has been a theme children. In 2019, the average country’s economic context.
in previous Report Cards. For unemployment rate across the 41 Although GNI is an imperfect
example, in Report Card 12, we countries included in this report measure because it does not
argued that: “Children feel anxious was 6 per cent, ranging from just evaluate what is produced or
and stressed when parents endure over 2 per cent in Japan to about consider the long-term costs and
unemployment or income loss, and 18 per cent in Greece. In many benefits of economic growth,51 it is
they suffer family downturns in countries, the unemployment rate still one of the most widely used
subtle and painfully evident ways”.50 has returned to its pre-crisis level, measures of goods and services
meaning before 2008, or dropped produced in an economy.
Not all adults can or want to work.
further. But this is not universally Historically, raising GNI resulted in a
To reflect this, we look at the
the case and, in some countries, surplus of goods that satisfied basic
unemployment rate for people
most notably Greece and Spain, the physiological needs, enabled the
between the ages of 15 and 64
unemployment rate remains well division of labour and, finally, gave
years who would like to work and
above the pre-crisis level (see rise to the modern phenomenon of
have taken active steps to find
Figure 34). leisure. Today, a high GNI can help
employment. In this way, we avoid
in building high-quality health care, inequality correlates with a lack of Putting equality at the heart of the
education and social protection. It trust. It erodes social cohesion and debate raises the concern that
also tends to coexist with labour empathy among citizens, both of ignoring levels of economic
arrangements that are conducive to which are preconditions for prosperity could lead to equality in
having more free time.52 meaningful political participation misery. Figure 35 shows that there
and democracy.54 is no obvious trade-off between
The relationship between national
inequality and income, however.
income and inequality In the policies section, we focused
Some of the less affluent countries
More equal societies tend to report on households with children. In this
have high inequality, while most of
higher life expectancy and fewer section, the Gini coefficient is used
the richer countries are more equal.
social problems such as violence, to show the distribution of income
Only the United States has very
mental illness, bullying among across the whole of society. The
high income and very high
children and teenage pregnancy.53 higher the Gini coefficient (on a
inequality. Its position should be
In unequal societies, it is more scale from 0 to 1), the higher the
seen as the exception rather than
difficult for disadvantaged groups to level of inequality.
the rule.
realize their full potential. Income
There is no trade-off between inequality and income

Figure 35: National income and income inequality
0.5
MX CL
0.45
0.4 TR
US
Income inequality
LT
BG
RO KR GB
0.35 LV NZ IL
CY ES JP
GR PT AU
IT
Average: 0.32
HR EE
CA IE
0.3 LU
MT DE CH
PL FR
HU SE AT NL
FI BE
DK NO
CZ IS
0.25
SK SI
Average: $42,925
0.2
10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000
National income per person (int. $)
Notes: Gross national income (GNI) based on purchasing power parity in international dollars (int. $) per capita in 2018 (2017 for Cyprus). Income inequality is
measured as income Gini coefficient from 2017 or the latest year available (2016 for Australia, Austria, Belgium, Czechia, Denmark, Estonia, France, Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Mexico, the Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain; 2015 for Croatia, Cyprus, Iceland, Japan,
Malta, Switzerland, Turkey; 2014 for Bulgaria, New Zealand). Orange lines represent cross-country averages.
Source: Data on GNI for all countries and on the Gini coefficient for Bulgaria, Croatia, Cyprus, Malta and Romania from: World Bank. Data on the Gini coefficient
for all remaining countries from: Organisation for Economic Co-operation and Development.
Spotlight 6 Infant mortality relates more

strongly to inequality than to income
During the first year of life, survival is measured using the All countries covered in this report have made impressive
infant mortality rate. During the remaining years of progress in systematically reducing infant mortality. Fifty
childhood, the child mortality rate is used. The two years ago, the average rate was 25 deaths per 1,000 live
indicators are driven by different factors and hence are births. This went down to 16 deaths per 1,000 live births
differently influenced by public policies. Infant mortality in 1978; 13 deaths per 1,000 live births in 1988; 8 deaths
reflects the quality of the health system, especially per 1,000 live births in 1998; 5 deaths per 1,000 live births
prenatal and neonatal care. In contrast, the child mortality in 2008; and 3.8 deaths per 1,000 live births in 2018.55
rate in rich countries tells us more about safety and mental Today, the relatively small differences between wealthy
health, as it is driven largely by accidents and suicide. countries reflect less the basic standards of public health
Income inequality matters more than national income for infant mortality
Figure 36: Infant deaths per 1,000 live births against national income and income inequality
12 12
MX MX
10 10
TR TR
8 8
R=0.66
Infant mortality
Infant mortality
RO RO
BGCL MT MT BG CL
6 6
US US
SK NZ SK NZ
CA CA
4 HR PL 4 PL HR
GR HU LT GB DK CH DK HU CH GR LV GB LT
LV FR NLFR IE AU
PT IL AU DE NL IE DE
KR BE AT BE AT PT IL
CZ ES IT CZ IT ES KR
EE SE NO LU NO SE LU EE CY
2 CY JP 2
SI SI JP
FI IS IS FI
R=-0.49
0 0
10 20 30 40 50 60 70 80 0.20 0.25 0.30 0.35 0.40 0.45 0.50
National income (int. $1,000) Income inequality
Notes: Infant deaths reported per 1,000 live births in 2018. For information on income and inequality, see note beneath Figure 35. The results hold
also when using log GNI (R=-0.57).
Source: Infant mortality rates: World Development Indicators 2018. Data on income and inequality: see Figure 35.
and more the efforts to reach out to every infant in the country grows richer and, finally, more progress can be made
earliest days and weeks of life, including those from the through reducing inequalities than through further growth.
most marginalized families.
Patterns are slightly different for child mortality. Here
In rich countries, infant mortality is more strongly linked to national income is as important as inequality (see Figure
income inequality than to national income (see Figure 36). 37). The best results are obtained by countries that are
Possibly, infant mortality follows the curve known from both rich and more equal, such as Denmark, Finland and
studies of life expectancy: additional economic growth Norway. Luxembourg is an outlier because it is rich and
brings an enormous premium at the early stages of has low child mortality but is less equal than the three
economic development, then the effect tapers off as the leading countries.
Income inequality and national income relate equally strongly to child mortality
Figure 37: Child mortality, gross national income and income inequality
3.0 3.0
2.5 MX 2.5 MX
2.0 TR
2.0 TR
BG BG
R=0.66
RO RO
Child mortality
Child mortality
1.5 CL LV 1.5 LV CL
SK LT SK LT
US US
EE EE
HR PL PL HR
GR GR
1.0 HU CA 1.0 HU CA
IL CY IL
PT CY MTNZ AU AT NLMT
CZ BE AT PT NZ
CZ KR GB NL AUJP GB
FR BE SE IS SI IS SE DE
FR
SI IT JP DE IT ES KR
ES IE CH NO
NO CH IE
FI FI
0.5 DK 0.5 DK
LU LU
R=-0.70
0 0
10 20 30 40 50 60 70 80 0.20 0.25 0.30 0.35 0.40 0.45 0.50
National income (int. $1,000) Income inequality
Notes: Child mortality covers all causes of death in the age range 5–14 years, reported per 1,000 children in 2018. For information on income and
inequality, see note beneath Figure 35. The results hold also when using log GNI (R=-0.77).
Source: Child mortality rates: United Nations Inter-agency Group for Child Mortality Estimation 2018. Data on income and inequality: see Figure 35.
In almost all countries, more than 1 in 20 adults has nobody to count on

Figure 38: Percentage of people who have someone they can count on in times of trouble
100
Average: 90.7%
90
Percentage of people who have someone to count on
80
70
60
50
40
30
20
10
97.6
96.0
95.9
95.5
94.8
94.6
94.4
94.0
93.6
93.5
93.5
93.4
93.3
93.1
93.1
92.7
92.7
92.7
92.0
92.0
91.9
91.8
91.6
91.5
91.3
90.8
90.7
90.6
90.5
90.0
89.7
88.9
88.8
87.0
86.8
85.0
82.6
81.3
81.0
80.5
78.3
0
Iceland
Finland
Norway
Denmark
New Zealand
Ireland
Australia
United Kingdom
Switzerland
Estonia
Slovenia
Netherlands
Malta
Lithuania
Bulgaria
Slovakia
Canada
Belgium
Czechia
Italy
Sweden
Spain
Luxembourg
Austria
France
Latvia
United States
Germany
Israel
Poland
Portugal
Japan
Hungary
Chile
Turkey
Mexico
Croatia
Romania
Cyprus
Republic of Korea
Greece
2016–18 2010–12
Note: Three-year averages are calculated to minimize survey bias for 2016–2018 and 2010–2012.
Source: World Happiness Report based on the Gallup World Poll.
Social context and crime are the two public issues Violence
We measure the social context that adolescents worry about most The country-level homicide rate
within each country as a whole (see Spotlight 7).56 reflects exposure to violence in its
using two indicators relating to most extreme form. Using it as a
Social support
social support and violence. Social proxy for social cohesion reduces
We use the percentage of people
support reflects a positive aspect of bias in international comparisons
who feel that they have someone
a community: the possibility to linked to definitions, legislation and
to count on if they are in trouble as
count on others in times of need. data availability. The average annual
a proxy for social support. On
Violence reveals rips in the social homicide rate across the countries
average, across the 41 countries,
fabric. A small proportion of people in this study was 2 homicide victims
91 per cent of adults reported that
in high-income countries fall victim per 100,000 people in 2017, ranging
they have someone to count on if
to crime, but many more are from a low of 0.2 homicides per
they are in trouble. The proportion
affected by its prospect, including 100,000 people in Japan to 5.3
of people who feel this way varies
children. In the United Kingdom, for homicides per 100,000 people in
by country, from 78 per cent in
example, 41 per cent of adolescents the United States and 24.8
Greece to 98 per cent in Iceland
worry about crime. The environment homicides per 100,000 people in
(see Figure 38).
Mexico. The average rate improved
The homicide rate dropped in 24 countries but remains high and rising in Mexico and the United States
Figure 39: Intentional homicides per 100,000 inhabitants in 2010 and 2017
25
20
7
6
Homicide (per 100,000)
Average: 2.0%
2
0.2
0.3
24.8
0.6
0.6
5.3
4.5
4.3
4.3
4.2
2.5
2.2
0.9
0.9
0.9
0.9
0.8
0.8
0.8
0.7
0.7
0.7
0.7
0.7
0.7
0.6
0.5
0.5
1.8
1.3
1.2
1.2
1.2
1.1
1.1
1.0
1.7
1.5
1.5
1.5
1.4
0
mbourg
Mexico
United States
Lithuania
Turkey
Chile
Latvia
Hungary
Estonia
Canada
Belgium
Slovakia
Romania
Bulgaria
Israel
France
United Kingdom
Finland
Denmark
Sweden
Croatia
Germany
Slovenia
Malta
Ireland
Iceland
Poland
Netherlands
Australia
Spain
Portugal
New Zealand
Italy
Greece
Austria
Republic of Korea
Czechia
Cyprus
Switzerland
Norway
Luxembourg
Japan
2017 or latest available 2010
Note: Data for the blue bars are from 2017 or the latest year available (2016 for Austria, Italy; 2015 for Israel, Malta; 2012 for Turkey).
Source: World Bank, 2017.
from around 2.2 homicide victims Additionally, an estimated They are also shorter and, hence,
per 100,000 people in 2010, despite 1.5 million premature deaths – closer to the ground level, where
the reverse trend in some countries. that is, deaths that occur before the pollution typically accumulates.60
average age of death in a certain High exposure can lead to long-
Environmental context
population – are caused each year term health problems such as
The natural environment is the by drinking unsafe water.59 asthma. Studies have shown that
primary support system for human some of this damage can be
life. It has an impact on people’s Air quality
reversed if action is taken before
health, leisure pursuits and social Air pollution harms everyone but
the child reaches the age of 18
relationships. Unsustainable takes the highest toll on children –
years, by which time the lungs are
environmental practices erode and it starts to harm them before
nearly mature.61
children’s current and future they are born. Toxic air inhaled by a
well-being. The World Health pregnant woman can lead to faster The smaller the pollution particles,
Organization estimates that cell ageing of the foetus. Children the more likely they are to move
4.2 million people die globally each are more vulnerable to air pollution from the lungs into the
year as a result of exposure to air than adults because they have a bloodstream and cause further
pollution.57 Toxic air contributes to smaller lung capacity and a less damage. For this reason, we use
more deaths than tobacco.58 well-developed immune system. the average annual concentration of
Children’s health is threatened by high levels of air pollution

Figure 40: Annual mean PM2.5 concentrations (μ/m3) in all areas in 2010 and 2017
45
40
35
PM2.5 concentrations
30
25
20
15 Average: 13.7
10
20.9
20.9
21.0
21.4
25.0
44.3
10.0
10.3
10.4
10.5
11.7
11.8
11.9
12.0
12.0
12.5
12.9
13.4
13.9
14.6
15.9
16.0
16.1
16.2
16.8
17.3
17.6
17.9
19.1
5.9
6.0
6.2
6.4
6.5
6.7
7.0
7.4
8.2
8.2
8.6
9.7
0
Norway
Portugal
Spain
Finland
New Zealand
Sweden
Canada
Iceland
Estonia
United States
Denmark
Luxembourg
Japan
Lithuania
Germany
Austria
Slovenia
Israel
Ireland
Australia
Switzerland
United Kingdom
France
Netherlands
Belgium
Latvia
Romania
Malta
Hungary
Czechia
Greece
Italy
Cyprus
Slovakia
Croatia
Bulgaria
Poland
Mexico
Chile
Republic of Korea
Turkey
2017 2010
Note: Population-weighted exposure to ambient PM2.5 pollution.

Source: World Development Indicators 2017; Brauer, Michael, et al., 2017, for the Global Burden of Disease Study 2017, ‘PM2.5 Air Pollution, Mean Annual Exposure
(Micrograms Per Cubic Meter)’, World Bank Data, <https://data.worldbank.org/indicator/EN.ATM.PM25.MC.M3>, accessed 25 February 2020; Brauer, Michael, et
al., ‘Ambient Air Pollution Exposure Estimation for the Global Burden of Disease 2013’, Environmental Science and Technology, vol. 50, no. 1, 2016, pp. 79–88.
fine particulate matter (PM2.5) as proportion of people satisfied with At the other end of the spectrum,
an indicator of environmental water quality in the place they live. the majority of people living in
context. Ambient PM2.5 pollution Safely managed water comes from Mexico do not have water that
averaged 13.7 micrograms (μg) per a protected water source that is meets this basic standard. In 11 of
cubic metre (m3) across the 41 rich located on the premises, available the 41 countries, at least 5 per cent
countries, ranging from 5.9 µg/m3 when needed and free from of households do not have safely
in Finland to 44.3 µg/m3 in Turkey. contamination.62 This is a minimum managed water. When asked
standard that the countries we whether they were satisfied with
Water quality
feature in this report should be able the quality of water in the place
Poor water quality hampers food
to meet given their historically where they live, 84 per cent of
hygiene and health. It can also
unparalleled wealth. In six countries – people across the countries said
present a burden on finances and
Greece, Iceland, Malta, New Zealand, yes. The proportion of satisfied
time and increase plastic waste, if
the Netherlands and the United people ranges from 65 per cent in
bottled water is used. We provide
Kingdom – over 99.9 per cent of the Turkey to 99 per cent in Iceland.
two perspectives on water quality:
population had access to safely
the proportion of households with
managed water (see Figure 41).
safely managed water and the
In most rich countries, more than 1 in 10 adults is not satisfied with the quality of water in the place where they live
Figure 41: Percentage of the population with safely managed water in 2017 and percentage of the population satisfied
with water quality in the place they live
Malta
New Zealand
Greece
Iceland
United Kingdom
Netherlands
Sweden
Germany
Slovakia
Luxembourg
Finland
Cyprus
Belgium
Israel
Poland
United States
Austria
Canada
Australia
Chile
Japan
Spain
Norway
Republic of Korea
Slovenia
Czechia
France
Ireland
Bulgaria
Denmark
Switzerland
Portugal
Latvia
Italy
Estonia
Lithuania
Croatia
Hungary
Romania
Mexico
Turkey
100 80 60 40 20 0 20 40 60 80 100
Percentage of population satisfied with water in 2016 Percentage of population with safely managed water in 2017
Percentage of population satisfied with water in 2010 Percentage of population with safely managed water in 2010
Notes: Countries ranked by safely managed water in 2017 (2016 in Australia). No water safety data for Turkey. Water satisfaction data refer to the proportion of
population aged 15 years and above who answered ‘Satisfied’ to the question ‘In the city or area where you live, are you satisfied or dissatisfied with the quality of
water?’. No water satisfaction data available for Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on safely managed water: WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), 2017 data, <https://
washdata.org>, accessed 25 February 2020. Data on water satisfaction: Organisation for Economic Co-operation and Development (OECD) Better Life Index
based on three-year average from the Gallup World Poll 2014–2016.
Spotlight 7 Environment and

young people’s well-being
Two in five young people in the United Kingdom worry about the environment
Figure 42: Attitudes of girls and boys in the United Kingdom towards environmental issues
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Girls 18% 27% 34% 15% 6%
Boys 13% 23% 36% 21% 7%
Very worried Quite worried A little worried Not at all worried Not sure
Note: Responses of children aged 10–17 years from the United Kingdom. Equally weighted by age and gender.
Source: The Children’s Society, The Good Childhood Report 2019, The Children’s Society, London, 2019.
It is hardly surprising that children are increasingly satisfaction.65 Research on children’s feelings about
speaking out about the environment. They are climate change is a new field, and representative data
growing up in the midst of the climate emergency are available only for a limited number of countries.
and will have to deal with it for the rest of their lives. In the United Kingdom, young people worry more
Yet, until recently, children have been largely ignored about the environment than about the economy,
in debates about the environment. Young people are Brexit, digital security or homelessness. Only
now forcing the world to pay attention to their views, crime merited the same degree of concern. Girls
either as individuals such as Swedish climate activist were more likely than boys to worry about the
Greta Thunberg, or collectively through initiatives environment (see Figure 42).
such as Youth for Climate. This international
In Australia, 59 per cent of young people consider
movement of students organized climate strikes in
climate change to be a threat to their safety (only
125 countries in March 2019, involving more than
14 per cent disagree). Climate change and plastic
1 million young people.63 “We are the voiceless
pollution top their list of environmental concerns
future of humanity”, said the strike’s organizers.64
(see Figure 43). Almost 90 per cent want to move to
What children think about the future relates to their renewable energy, while only 3 per cent want to ‘stay
current well-being. For example, children who worry with fossil fuels’. Three out of four adolescents in
about the environment tend to have lower life Australia want their government to act.66
In Australia, climate change is the biggest environmental concern for adolescents

Figure 43: Environmental concerns of adolescents in Australia
Climate change 71
Plastic pollution 64
Extinction of animals 63
Air pollution 63
Ocean pollution 63
Deforestation 59
Damage of the reef 59
Littering 56
Recycling crisis 53
Over-fishing 45
Extinction of plants 42
0 10 20 30 40 50 60 70 80
Percentage of adolescents who report being worried about a given issue
Note: Responses of 1,007 children aged 14–17 years; sample representative of Australia.
Source: United Nations Children’s Fund Australia, 2019.
Figure 44: A league table of conditions (policies and context) for child well-being
Policies Context
Ranking Country
Social Education Health Economy Society Environment
1 Norway 6 9 8 1 2 7
2 Iceland 10 19 1 6 1 4
3 Finland 5 12 5 22 3 2
4 Germany 9 6 19 7 25 16
5 Denmark 12 16 12 9 4 17
6 Sweden 18 17 2 15 22 3
7 Luxembourg 23 1 24 2 15 11
8 Ireland 26 14 10 5 6 9
9 Netherlands 21 3 23 8 10 15
10 Slovenia 3 11 15 25 11 26
11 Switzerland 30 8 26 3 8 22
12 Estonia 1 33 11 27 18 14
13 Poland 8 5 13 23 26 33
14 Austria 13 13 33 10 21 20
15 Lithuania 15 2 9 30 30 30
16 Latvia 11 4 4 36 31 25
17 Japan 7 23 34 11 29 18
18 Australia 28 32 18 13 7 8
19 Czechia 4 22 36 14 13 28
20 New Zealand 37 20 22 21 5 1
21 Malta 32 15 21 20 12 23
22 Portugal 22 7 27 29 27 13
23 Canada 27 25 29 19 23 5
24 Belgium 29 10 32 17 20 19
25 Republic of Korea 17 21 6 16 38 38
26 Hungary 2 34 17 24 32 36
27 United Kingdom 35 24 30 12 9 10
28 Slovakia 16 38 14 31 19 29
29 United States 41 30 28 4 33 6
30 Croatia 20 27 7 37 36 37
31 Israel 39 26 20 18 28 34
32 France 25 18 39 28 24 21
33 Spain 36 31 25 40 17 12
34 Italy 34 35 31 33 16 31
35 Bulgaria 19 39 37 34 14 32
36 Chile 33 37 16 38 34 35
37 Cyprus 24 28 38 35 37 27
38 Romania 14 40 40 26 39 39
39 Greece 31 29 41 41 40 24
40 Mexico 38 36 3 32 41 40
41 Turkey 40 41 35 39 35 41
Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in
the table were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive
condition); (2) we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, we
then calculated the mean of the mean z-scores for each dimension.
A league table of conditions the Context dimensions – economy, good or poor conditions and
for well-being society and environment – but in outcomes. There is a cluster of
We conclude this section with a the middle third for health policy countries in the top right quadrant,
summary league table of national and the bottom third for social and indicating good conditions and high
conditions that support child well- education policies to support child outcomes. These include Denmark,
being (see Figure 44). These well-being. In contrast, Lithuania is Finland, the Netherlands and
conditions consist of the two in the top or middle third for each Norway. All are in the top 10
outermost levels of our model of the Policy dimensions, while countries on both conditions and
(see Box 1): being in the bottom third for each outcomes. Six countries are in the
Context dimension. New Zealand is bottom left quadrant, indicating
1. Policies. The social, education ranked first for environment relatively poor national conditions
and health services and because of its clean air and safe for child well-being and low child
programmes that have a bearing water. Yet its overall ranking also well-being outcomes. Most of
on children’s lives. takes high child poverty and short these are countries with a lower
2. Context. The overall economic, parental leave into account. national income, but they also
social and environmental include the United States. There are
The link between conditions
context in the country. also countries with a weaker match
and outcomes
between conditions and outcomes.
We rank all 41 countries on the A test of our framework is the France and Spain, in the top left
various components of Policies and extent to which the national quadrant, rank much higher for
Context and give each country an policies and Context – together outcomes than they do for
overall ranking. called ‘conditions for child well- conditions. On the other hand,
being’ – are associated with child Lithuania, Malta and New Zealand
Norway is ranked highest for the
well-being outcomes. We would stand out in the bottom right
conditions that support child well-
not expect an exact match, as a quadrant as having above-average
being, followed by Iceland and
variety of unmeasured factors also conditions but relatively poor
Finland. Turkey is ranked lowest,
influence well-being outcomes, outcomes. The mismatch between
followed by Mexico and Greece.
including time lags between conditions and outcomes should
There is a lot of variation in country
improvements in conditions and prompt reflection, particularly in
rankings across the six dimensions.
outcomes, but we should expect a countries which rank much lower
Only Norway ranks in the top third for
reasonably strong association. for outcomes than they do for
all six dimensions, and only Turkey is
Figure 45 shows that this is the conditions. The reasons for these
in the bottom third for all six. There is
case. In general, countries that rank patterns are likely to be complex
plenty of room for improvement in
highly for the broad conditions and to require more detailed
the conditions for child well-being
listed in the second league table analysis according to each
across all 41 countries.
also have a high ranking for the country’s context.
Some countries have large well-being outcomes identified in
variations in rankings across the six the first league table.67
dimensions. For example, Australia
The quadrants on the chart show
is ranked in the top third for each of
whether countries have relatively
Child well-being outcomes reflect but do not match national conditions for child well-being
Figure 45: Z-scores of country rankings of national conditions plotted against rankings of well-being outcomes
Poor conditions, good outcomes Good conditions, good outcomes

France, Spain Denmark, Finland, Netherlands,
Norway, Slovenia, Switzerland
1.5
NL
DK
1.0
NO
CH
ES FI
FR
BE
SI
0.5
LU
HR IE SE
DE
HU PT AT
CY
IT
KR JP
CZ
-1.5 -1.2 -0.9 -0.6 -0.3 0.0 0.3 0.6 0.9 1.2
Outcomes
EE
IS
RO
SK GB LV
GR CA
-0.5 PL
AU
LT
-1.0 MT
R=0.42
US NZ
BG -1.5
CL
-2.0
Conditions
Poor conditions, poor outcomes Good conditions, poor outcomes

Bulgaria, Chile, United States Lithuania, Malta, New Zealand
Note: The chart is based on the mean of z-scores for each dimension, for indicators of conditions and outcomes respectively, and so the relative positions of
countries do not exactly match those shown in Figure 3 and Figure 44.
Source: See Figure 3 and Figure 44.
S E C T I O N 6 W H A T C A N C O U N T R I E S D O T O I M P R O V E C H I L D W E L L - B E I N G ?
SECTION 6
WHAT CAN COUNTRIES DO TO
IMPROVE CHILD WELL-BEING?
Figure 46: The cascading impacts of the COVID-19 crisis on child well-being
Falling GDP, job loss

Increased social tensions
Context
Environmental change
Policies Strain on health services

School closures
Rising poverty
Resources
Networks The world around

the child acts as a
prism through
which the impact of
ationships
Rel societal changes is
lessened or
intensified
Activities
Unequal impacts on children:

Poorer physical health
Poorer mental well-being
Outcomes Losses in skills
The world around the child
The world at large
The richest countries in the world in countries with already under- lockdown has already seen an
are failing to ensure that all their resourced health care. increase in gender-based violence.
children have a good childhood. The new burdens of caring for
The extent of the shortcomings
Education. School closures were children and home schooling have
applied to contain COVID-19 in
varies between countries, but poor fallen disproportionately on women.
almost all countries covered in
mental and physical health, and a The initial impacts have also been
this report. Online schooling has
lack of satisfactory academic and unevenly spread across sectors.
brought mixed results.
social skills are features of many Many better-paid workers in office
childhoods in all countries. Social protection. Rising professions continued to earn
unemployment and job insecurity through a switch to working from
Report Card 16 provides a baseline
will strain many families financially home. This has not happened for
of how countries were faring in
and psychologically. During an many lower-paid manual workers
terms of child well-being at the start
economic recession, increasing reliant on government aid schemes.
of the COVID-19 crisis. It introduces
social protection can be more Informal sector workers have been
a new conceptual framework of
difficult but also more needed. hardest hit and some have faced
child well-being which can now be
barriers accessing any financial
used to understand how effects of The impacts on children
support.
COVID-19 will cascade down from Physical health. Children’s
the national context through the physical health will be affected in The impacts on children will
immediate world around the child the short and long term. In the probably follow the scenario of
to affect well-being (see Figure 46). short term, strained health rising inequalities. A child living in
systems can deprioritize routine a well-off family, with a room of
The effects of the COVID-19
immunizations or treatment of their own, a good Internet
crisis on national conditions
chronic health conditions. In the connection, and parents who have
Economy. GDP will probably fall, long term, rising levels of poverty the time, skills and confidence to
even in the best-protected support home learning will suffer
can affect children’s health
countries. Its shock effects will the educational impact of school
through nutrition, housing and
reverberate throughout economies closures less than a child in a
living conditions.
and strain funding for policies to family with poorer material and
support child well-being. Mental well-being. The existing human resources. The world
children’s mental health crisis will
Society. The impacts of the crisis around the child can cushion or
probably intensify. The
are likely to be felt unequally, intensify the effects of events in
experiences of lockdown,
putting a pressure on the fabric the world at large.
bereavement and ongoing strains
of societies, decreasing trust and The COVID-19 crisis therefore
on family relationships of
engendering tensions. presents three challenges for
economic uncertainty can damage
Environment. The initial drop in many children’s mental well-being. nations and governments in terms
human-caused pollution during Children may feel anxious, of maintaining and promoting the
lockdowns was a temporary insecure and fearful for the future. well-being of their children:
respite for the natural 1. To minimize the impact of the
environment. But it is unlikely to
Skills. In most countries, children
have missed months of education COVID-19 crisis on children.
last. As economies try to make
and peer contact. Previous crises 2. To provide effective support for
up lost ground, environmental
have shown that many children those children who do suffer
damage may increase.
will never make up for this loss of negative impacts.
Health. The huge demands on learning. This will have longer-
health services during the COVID- term impacts on their lives and on 3. To ensure that these actions
19 crisis are likely to have the societies in which they live. acknowledge and minimize
crowded out other health needs inequalities.
Rising inequalities
and weakened systems, especially
The impacts of the COVID-19 crisis
will be distributed unevenly. The
Policies Connect policies: Improve policies that set a strong

Based on the evidence presented children’s well-being through an foundation for children and for
in this report, UNICEF calls for all integrated approach society as a whole. The Sustainable
high-income countries to act on An integrated approach to child Development Goals provide an
three fronts: well-being means acknowledging excellent basis for intensifying and
the links and trade-offs between accelerating improvements in child
Consult children: Improve well-being globally. The evidence in
child well-being outcomes and
children’s well-being through a this report suggests a range of
national conditions and coordinating
shift in thinking actions that are essential to
public policies appropriately. The
Ensuring that all children have a report has shown how conditions at achieving these goals, including:
good childhood requires a shift in different levels of a child’s world 1. Taking new and decisive action
thinking about what ‘well-being’ interact to influence their well-being. to reduce income inequality and
means and who should decide Employment regulation is a good poverty, and ensuring that all
about it. Children’s and young example. Children’s personal children have access to the
people’s ideas about well-being do happiness is linked to family resources they need.
not always match those of adults. relationships. Yet parents who work
This is evident in findings presented long hours struggle to find a 2. Improving access to affordable
in this report about their serious balance between work and family. and high-quality early years
concerns for the future of the Employment policy connects with childcare for all children.
environment, how much they value child well-being, a fact that millions 3. Improving mental health services
good-quality relationships and their of families in high-income countries for children and adolescents.
views on personal autonomy. Adult can attest to. To be effective and
decision-makers at all levels, from 4. Implementing and expanding
efficient, child well-being
parents to politicians, need to be family-friendly policies related to
interventions need an integrated
willing to listen to these the workplace.
approach that recognizes how
perspectives and take them into policy actions at one level will 5. Reducing the stubbornly high
account when designing policies influence another. Governments levels of air pollution, among a
and allocating resources. typically assess the economic range of measures to protect the
Governments should strengthen the impact of legislation and policy. natural environment.
opportunities for children’s voices They should also consider routinely
to be systematically heard. This can 6. Strengthening efforts to protect
incorporating an equivalent
be achieved through child-friendly, children from preventable
assessment of their impact on
public policy consultations; diseases, including reversing
children’s well-being.68
ensuring all children know their recent falls in many countries in
rights; and creating new ways to Create strong foundations: Sustain measles immunization.
take account of children’s views in improvements for child well-being
These are steps that every
schools, communities and nations. through future-proofing
government can take to improve
Children’s participation in society is Governments must plan and the lives of children in the present
part of consensus- building prepare for the future to ensure that and the future. Every child deserves
between generations on what improvements in child well-being a good childhood.
matters most. are sustained. This means choosing
ABBREVIATIONS
International Standards Organization Abbreviations and acronyms used in

international abbreviations for countries Report Card 16
included in Report Card 16
AT Austria IT Italy BMI Body mass index

AU Australia JP Japan DPT Diphtheria-pertussis-tetanus
BE Belgium KR Republic of Korea EQLS European Quality of Life Survey
BG Bulgaria LT Lithuania EU European Union
CA Canada LU Luxembourg Eurostat Eurostat Statistical Office
of the European Union
CH Switzerland LV Latvia
EU-SILC EU Statistics on Income
CL Chile MT Malta
and Living Conditions
CY Cyprus MX Mexico
GNI Gross national income
CZ Czechia NL Netherlands
HBSC Health Behaviour in
DE Germany NO Norway School-aged Children
DK Denmark NZ New Zealand HILDA Household, Income and Labour
EE Estonia PL Poland Dynamics in Australia Survey
ES Spain PT Portugal NEET Not in education,

employment or training
FI Finland RO Romania
OECD Organisation for Economic
FR France SE Sweden Co-operation and Development
GB United Kingdom of Great Britain SI Slovenia PISA Programme for International
and Northern Ireland Student Assessment
SK Slovakia
GR Greece PM2.5 Fine particulate matter
TR Turkey
HR Croatia SDG Sustainable Development Goal
US United States of America
HU Hungary UNESCO United Nations Educational,
IE Ireland Scientific and Cultural
Organization
IL Israel
UNICEF United Nations Children’s Fund
IS Iceland
WHO World Health Organization
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59. Ibid.
decreasing long-term conditions for
well-being. These issues with national 60. When children are born, they tend to
income have long been recognized – see, have only one fifth of the adult lung mass.
for example, a speech made by Robert Before they reach the teenage years, they
Kennedy, delivered on 18 March, 1968 at breathe faster, inhale more air and tend to
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national product that “measures everything toxic air is inhaled, the ability to fight its
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learn/about-jfk/the-kennedy-family/ amount of pollution is more likely to cause
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speeches/remarks-at-the-university-of- among healthy adults. Furthermore, in
kansas-march-18-1968>. But they remain those places where air pollution stems
largely unresolved and are becoming more primarily from vehicles, it tends to
pertinent as evidence of environmental accumulate close to the ground, meaning
problems mounts. that the lower the human height, the higher
the exposure.
ACKNOWLEDGEMENTS
Innocenti Report Card 16 was written by Yekaterina Chzhen is an Assistant Professor

Anna Gromada, Gwyther Rees and of Sociology at Trinity College Dublin. She
Yekaterina Chzhen with contributions from moved to Trinity in August 2019 from the
Dominic Richardson, Celine Little and David UNICEF Office of Research – Innocenti,
Anthony. The report was fact-checked by where she had been a Social Policy
Alessandro Carraro, supervised by Gunilla Manager since 2013. She holds a PhD from
Olsson and Priscilla Idele and edited by the University of York and publishes on
Madelaine Drohan. poverty and inequality across the life
course. She tweets from @kat_chzhen.
A panel of advisers and UNICEF reviewers
provided quality assurance. Support and
advice were provided by Laurence Chandy, Advisory board
Alessandra Guedes, Daniel Kardefelt
Ársæll Már Arnarsson (Health Behaviour in
Winther, Amenawon Njilan Esangbedo,
School-aged Children, Iceland)
Nikita White and all UNICEF National
Committees. Administrative support at the Asher Ben-Arieh (Haruv Institute, Hebrew
UNICEF Office of Research – Innocenti was University of Jerusalem)
provided by Cinzia Iusco Bruschi, Lisa
Mario Biggeri (Università degli Studi di
Gastaldin and Flora Zecchi. Production was
Firenze)
led by Sarah Marchant, and communication
and outreach by Dale Rutstein, Patrizia Jonathan Bradshaw (University of York)
Faustini and Kathleen Sullivan.
Dorothy Currie (Health Behaviour in
All related materials can be downloaded School-aged Children, University of St
from the UNICEF Office of Research – Andrews)
Innocenti website: www.unicef-irc.org
Enrique Delamonica (UNICEF New York
Headquarters)
Authors
David Gordon (University of Bristol)
Anna Gromada is a Social and Economic
Jo Inchley (Health Behaviour in School-
Policy Consultant at the UNICEF Office of
aged Children, University of Glasgow)
Research – Innocenti, a researcher at the
Polish Academy of Sciences and a Bergsteinn Jónsson (UNICEF Iceland
co-founder of the Kalecki Foundation. Prior National Committee)
to this, she collaborated with the
Dagmar Kutsar (University of Tartu)
Chancellery of the President of the
Republic of Poland, the Organisation for Gill Main (University of Leeds)
Economic Co-operation and Development
Luisa Natali (UNICEF Office of Research –
and the Government of France. She holds
Innocenti)
degrees in Economics, Development,
Sociology and Politics. Mario Piacentini (Organisation for
Economic Co-operation and Development)
Gwyther Rees is a Social and Economic
Policy Manager at the UNICEF Office of Laura Speer (KIDS COUNT, Annie E. Casey
Research – Innocenti. In addition, he is an Foundation)
Associate Research Fellow at the
University of York, where he is also Ramya Subrahmanian (UNICEF Office of
Research Director of Children’s Worlds – a Research – Innocenti)
global survey of children’s views on their
lives and well-being. He has a PhD from
Cardiff University and a research
background in child protection and
children’s subjective well-being.
Previous issues in this series:
A League Table of Child Poverty in Rich Nations

A League Table of Child Deaths by Injury in Rich Nations

A League Table of Teenage Births in Rich Nations

A League Table to Educational Disadvantage in Rich Nations

A League Table of Child Maltreatment Deaths in Rich National

Child Poverty in Rich Countries 2005

Child Poverty in Perspective: An overview of child
well-being in rich countries

The Child Care Transition: A league table of early childhood
education and care in economically advanced countries

The Children Left Behind: A league table of inequality in child
well-being in the world’s rich countries

Measuring Child Poverty: New league tables of child poverty in
the world’s rich countries

Child Well-being in Rich Countries: A comparative overview

Children of the Recession: The impact of the economic crisis on
child well-being in rich countries

Fairness for Children: A league table of inequality in child
well-being in rich countries

Building the Future: Children and the Sustainable Development
Goals in rich countries

An Unfair Start: Inequality in children's education in
rich countries
for every child, answers
UNICEF Office of Research – Innocenti

Via degli Alfani 58
50121 Florence, Italy
Tel: +39 055 2033 0
Fax: +39 055 2033 220
florence@unicef.org
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Print ISSN: 1605-7317

Online ISSN: 2519-108X
© United Nations Children’s Fund (UNICEF)

September 2020
ISBN: 978-92-1-103307-6
eISBN: 978-92-1-005303-7
Sales no.:E.20.XX.1

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Innocenti Report Card 16

In 1988, the United Nations Children’s Fund (UNICEF) established a research

Cover photo © Dissolve/fStop

UNICEF Office of Research – Innocenti

Graphic design: MCC Design, UK (mccdesign.com)

 Measles immunization rates have  In 11 of 41 countries, at least adolescents.

 Public provision of high-quality  High levels of air pollution still workplace.

Spotlight 1 About the data used in this report

Figure 2 shows how we have additional dimensions. For example,

Figure 2: Overview of the application of the framework for this report

world the chil

Box 1: Indicators used in the report

Dimension Components Indicators Source

Play Playing outside Children’s Worlds, 2017–19

Percentage of children aged 10 totally agreeing that

Household resources School books at home PISA, 2018

Overall ranking Country Mental well-being Physical health Skills

league table. Romania 85

Positive functioning encompasses Finland 84

various components including Croatia 82

on the scale), but there was Greece 76

Suicide rate per 100,000 people aged 15–19 years

Spotlight 2 Body image relates to life satisfaction

Source: Health Behaviour in School-aged Children (HBSC) 2018.

of age. Even in the best-performing France 67

country, Estonia, more than one Netherlands 66

in five children do not meet the New Zealand 65

basic proficiency standard. In five Switzerland 65

countries, less than half of children Sweden 64

close to the child – their daily lives Estonia 71

and their closest relationships – Poland 70

In this section and the next, we

International comparative studies of

satisfaction as an indicator because 9.0

for children. There were also strong 9.7

Spotlight 3 Screen time has a small negative influence,

Children are online almost twice as long than a decade ago

Spotlight 4 Protection and provision do not

Romania 67 Spain (Catalonia) 58

Republic of Korea 51 Hungary 42

Greece (Epirus) 50 Norway 41

Spain (Catalonia) 50 Greece (Epirus) 41

Switzerland 48 Belgium (Flanders) 41

Italy (Liguria) 47 Republic of Korea 39

Belgium (Flanders) 46 Italy (Liguria) 38

In this section, we look at ‘the

Networks around the child

Support for parents

Family Friends Service Nobody

Inability to fulfil family responsibilities relates to long working hours

Average weekly hours worked in main job (2016)

satisfied) that averaged the answers Slovenia 7.8

Are there enough places to play? Happiness

Totally agree Did not totally agree

The world of the child and the

In the next circle outwards (Policies),

2018 (or latest available) 2014 2008

2.5 Average: 2.4% GDP

Cash Services Tax breaks

Spotlight 5 Poor children in the United Kingdom

Persistent poverty impedes children’s development

None Once 2 to 4 times 5 or 6 times

In 22 European countries, more than 1 in 10 parents has an unmet childcare need

Measles immunization rates have In 11 of 41 countries, at least adolescents.

Public provision of high-quality High levels of air pollution still workplace.